UpToDate helps Lauren develop a management plan
for a high-risk pregnancy
When presented with a medical challenge in her life, Lauren's
way of coping is learning everything she can about the condition.
Lauren, a 45-year-old who lives in Wahiawa, Hawaii, has undergone
two open heart surgeries to manage her severe
mitral regurgitation,
a disorder that allows blood to leak backwards through one of the
four main heart valves. Lauren's valve was so badly damaged that she
needed to have the valve replaced. The first valve replacement, a
porcine bioprosthesis, was not successful and in October of 2000 she
had the valve replaced with a mechanical prosthesis.
Lauren's medical challenge
Lauren became pregnant after the second valve replacement.
She knew that pregnancy presented a unique set of problems for women
with mechanical heart valves. Mechanical heart valves are associated
with an increased risk of blood clots (thromboembolic events) during
pregnancy, and these blood clots can be life threatening for the
mother and baby. Anticoagulation (thinning the blood) with oral
anticoagulants, usually warfarin, provides protection against these
complications, but its use during certain times in pregnancy can
increase the risk of birth defects and stillbirth. Lauren knew that
she would need to work closely with her doctor to develope a
detailed management plan for her pregnancy.
"Generally when women get mechanical heart valves physicians
discourage them from becoming pregnant," states Lauren. "Certainly
there are other women out there like me, but it's not all that
common and none of the healthcare professionals I had access to had
direct clinical experience managing a patient like me," said Lauren.
A web search leads her to UpToDate
To learn more about a management plan Lauren went online and
started looking for information. "I searched medical journals and
went on Medline to look for specific articles, but didn't always
have access to complete articles and wasn't finding enough that was
really current," explains Lauren. "Then I did a Google search and
found an article on
Management of pregnant women with prosthetic heart valves
in UpToDate and I thought, 'Wow this is a great site,
exactly what I'm looking for'."
“I subscribed to UpToDate
because I thought it was important that I really understand my
options.”
"I subscribed to UpToDate because I thought it was
important that I really understand my options," states Lauren. "It
is not written in stone exactly what is supposed to be done in these
cases and there is some room for alternative decision making, so I
wanted the latest clinical research and opinions."
She shares information from UpToDate with her
physician
By reading in UpToDate Lauren learned that there are
a lot of issues around anticoagulation, which is a requirement when
you have a mechanical valve, but tricky as you proceed through the
pregnancy. "I ended up printing the articles and offered them to my
doctor, who recognized 'UpToDate' which is available
through the hospital's medical library. I reviewed as much of the
literature as I could and then gave her what I thought was the best
and most current discussion of the topic and suggested that it might
help us develop a good management plan."
Lauren and her doctor develop a management plan
Lauren developed a management plan with her doctor. During
week 35 of her pregnancy she would be hospitalized for several days
and put on intravenous heparin (another blood thinner) to determine
the correct dosage. Following that Lauren will stay on
unfractionated heparin for the remainder of the pregnancy. Her
doctor did not plan to induce labor or do a planned c-section
unless it was necessary. She would wait to go into labor
naturally. However, in case she needed a c-section, her doctor set-up a plan
at the hospital in advance so that they would be prepared.
Lauren believes that having access to the information in UpToDate
improved the quality of care she received during her pregnancy and
also improved her relationship with her physician. Lauren concludes,
"I think it enriches the relationship you have with your doctors,
because they see you are really involved and you can ask appropriate
questions. UpToDate gave me greater peace of mind and I
think it helps my doctor because we are working as a team."
Update:
While in the hospital for bridge therapy from coumadin to
heparin, Lauren had an emergency c-section and delivered a 4 pound 7
ounce baby boy. Both mom and baby did well. Lauren says, "A
lot of docs were involved in my and my baby's care--high risk OBs,
cardiologists, anesthesiologists, pediatricians, and neonatologists.
The teamwork was impressive and everything turned out well in the
end!"
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