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AJP Rep 2012; 02(01): 047-050
DOI: 10.1055/s-0032-1316463
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Intracranial Hemorrhage in Pregnancy

Afshan B. Hameed
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California-Irvine Medical Center, Orange, California
,
Vineet K. Shrivastava
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California-Irvine Medical Center, Orange, California
,
Lisa Blair
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California-Irvine Medical Center, Orange, California
,
Deborah A. Wing
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California-Irvine Medical Center, Orange, California
› Author Affiliations
Further Information

Publication History

13 December 2011

03 March 2012

Publication Date:
27 June 2012 (online)

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Abstract

A pregnant woman with a mechanical prosthetic mitral valve was anticoagulated with low-molecular-weight heparin in the first trimester followed by warfarin until 36 weeks' gestation. She was then switched to intravenous unfractionated heparin infusion to allow for regional anesthesia in anticipation of vaginal delivery. She developed severe headache on hospital day 2 that was refractory to pain medications. Cranial imaging demonstrated a large subdural hematoma with midline shift. She delivered a healthy baby girl by cesarean section. Eventually, symptoms and intracranial abnormalities resolved over time. In conclusion, subdural hematoma is a relatively rare complication that requires multidisciplinary management plan.

Keywords

anticoagulation - pregnancy - prosthetic heart valve - heparin
 

  • References

  • 1 Born D, Martinez EE, Almeida PA , et al. Pregnancy in patients with prosthetic heart valves: the effects of anticoagulation on mother, fetus, and neonate. Am Heart J 1992; 124: 413-417
    CrossrefPubMedGoogle Scholar
  • 2 Vongpatanasin W, Hillis LD, Lange RA. Prosthetic heart valves. N Engl J Med 1996; 335: 407-416
    CrossrefPubMedGoogle Scholar
  • 3 Srivastava AR, Modi P, Sahi S, Niwariya Y, Singh H, Banerjee A. Anticoagulation for pregnant patients with mechanical heart valves. Ann Card Anaesth 2007; 10: 95-107
    CrossrefPubMedGoogle Scholar
  • 4 American College of Obstetricians and Gynecologists. ACOG Committee Opinion: safety of Lovenox in pregnancy. Obstet Gynecol 2002; 100: 845-846
    CrossrefPubMedGoogle Scholar
  • 5 Bonow RO, Carabello BA, Chatterjee K , et al. American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease). Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2008; 52: e1-e142
    CrossrefPubMedGoogle Scholar
  • 6 Elkayam U, Bitar F. Valvular heart disease and pregnancy: part II: prosthetic valves. J Am Coll Cardiol 2005; 46: 403-410
    CrossrefPubMedGoogle Scholar
  • 7 Choi C, Midwall S, Chaille P, Conti CR. Treatment of mechanical valve thrombosis during pregnancy. Clin Cardiol 2007; 30: 271-276
    CrossrefPubMedGoogle Scholar
  • 8 Phan TG, Koh M, Wijdicks EFM. Safety of discontinuation of anticoagulation in patients with intracranial hemorrhage at high thromboembolic risk. Arch Neurol 2000; 57: 1710-1713
    CrossrefPubMedGoogle Scholar
  • 9 Bertram M, Bonsanto M, Hacke W, Schwab S. Managing the therapeutic dilemma: patients with spontaneous intracerebral hemorrhage and urgent need for anticoagulation. J Neurol 2000; 247: 209-214
    CrossrefPubMedGoogle Scholar