Treatment of heart valve disease during pregnancy

Heart valve disease constitutes the majority of all causes of heart disease during pregnancy. Women with heart valve disease are vulnerable to deterioration with subsequent increased risk of maternal and fetal morbidity and mortality.

The optimal treatment is indecisive; on one hand medical treatment might relieve symptoms but causes hypoxia and have adverse effects on the developing fetus, while interventional therapy might increase the risk of maternal and fetal complications. No randomised controlled trials addressing the optimal treatment have been performed. Therefore, there is insufficient evidence to define the optimal treatment of heart valve disease during pregnancy. 

Additional. Observational studies are the only available information on this subject. This implies a selection bias; case series with reasonable outcome might be reported more frequent than those with poor outcome. Although observational studies might imply a selection bias, these studies are the best available evidence in adverse maternal and neonatal effects and are described in detail.

Authors' conclusions: 

There is insufficient evidence to define the most effective treatment of valvular heart disease in pregnancy to improve maternal and neonatal outcomes.

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Background: 

Valvular heart disease constitutes the majority of all causes of heart disease in pregnancy. In the presence of valvular heart disease, the necessary haemodynamic changes of pregnancy might cause heart failure, leading to severe maternal and fetal morbidity and even mortality. Treatment of valvular heart disease is indicated when patients experience a deterioration of symptoms and in case of a severe valvular lesion. Whether medical therapy or interventional therapy is the optimal treatment for both mother and child is unclear.

Objectives: 

To assess effectiveness and adverse effects of the different treatment modalities of valvular heart disease in pregnancy to improve maternal and neonatal outcomes.

Search strategy: 

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 March 2011), EMBASE (1980 to 23 March 2011) and the reference lists of background review articles.

Selection criteria: 

Randomised controlled trials, quasi-randomised controlled and cluster-randomised controlled trials comparing medical therapy with percutaneous or surgical intervention for the treatment of valvular heart disease in pregnancy.

Data collection and analysis: 

We identified no (randomised) controlled trials to assess the effectiveness and adverse effects of the treatment of valvular heart disease in pregnancy.

Main results: 

There were no randomised controlled trials, quasi-randomised controlled trials or cluster-randomised trials identified from the search strategy.

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