Reproductive health among women of child-bearing age after surgery for Rheumatic Heart Disease in Rwanda.

To determine maternal and fetal outcomes in postoperative women with RHD who become pregnant after valve surgery and evaluate current anticoagulation management during pregnancy. Data from the Rwandan RHD cardiac surgical registry identified all female patients who underwent valve surgery before or during childbearing age since 2006. 136 participants completed a mixed-methods questionnaire detailing each pregnancy after surgery, including anticoagulation regimen and outcomes. 38.2% (n=136) of patients reported at least one pregnancy after surgery, of which more than half were unintentional (53.9%, n=52). Among those with mechanical valves, most remained on warfarin alone during pregnancy (58.5%, n=53) while one third were switched to low molecular weight heparin during the first, second, or third trimesters (5 vs. 4 vs. 7, n=18). Women with bioprosthetic valve replacement or valve repair were more likely to experience live term births (84.6% vs 45.3%, p<0.01) and less likely to report spontaneous abortion (3.9% vs 30.2%, p<0.01) compared to women with mechanical valve replacement. Excessive bleeding was the most common complication during pregnancy (9.1%, n=79), and two infants were diagnosed with congenital defects associated with warfarin embryopathy (4.8%, n=42). Despite preoperative counseling discouraging conception, many women with prosthetic valves still become pregnant after surgery. The results of this study will inform evidence-based and context-specific practices for anticoagulation during pregnancy in Rwanda and the region.

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