Читать книгу Assisted Reproduction Techniques - Группа авторов - Страница 100

Anna S. Herrey1 and Catherine Nelson-Piercy2

1 Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK

2 Department of Women’s Health, Guy’s and St Thomas’ Foundation Trust, London, UK

Case History 1: A 42‐year‐old woman is being assessed for IVF treatment. She smokes 20 cigarettes per day and has chronic hypertension and diet‐controlled type 2 diabetes mellitus. Her body mass index (BMI) is 33 kg/m2. She takes ramipril 10 mg once a day and simvastatin 20 mg once a day. Because of her increased risk of ischemic heart disease, she is advised to undergo ischemia testing before receiving infertility treatment.

Case History 2: A 27‐year‐old patient is attending with her partner to discuss IVF. She has had a mechanical mitral valve replacement 2 years previously for rheumatic mitral valve stenosis and is currently taking 7 mg/day warfarin. She reports normal exercise tolerance. Appropriate preconception counseling is provided, including a discussion about the choice of anticoagulant (vitamin K antagonist or low‐molecular weight heparin with anti X‐a monitoring) as well as the high risk of thromboembolic and bleeding complications she is taking (direct oral anticoagulants are ineffective in mechanical heart valves and contraindicated in pregnancy).

Case History 3: A 53‐year‐old woman with a previous medical history of breast cancer treated with chemotherapy and severe left ventricular (LV) impairment presents to the obstetric service at 14 weeks gestation. She had received IVF with oocyte donation in another country and had no preconception counseling or cardiac risk assessment prior to pregnancy. She had been advised to discontinue all her cardiac medications including ramipril and bisoprolol. The woman undergoes preconception counseling alerting her to the risk of LV function deterioration, arrhythmia and increased risk of cardiac events and possible poor fetal outcome. She is restarted on betablocker, with the plan of keeping her on this drug throughout the pregnancy (ACE‐inhibitors are contraindicated in pregnancy but not while breastfeeding).