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Challenges in the management of pregnant patients with cardiovascular diseases
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  • Published on: 23 October 2020
    Risk stratification using DEVI's score in pregnant women with RHD
    • Anish Keepanasseril, Additional Professor (Obgyn) Department of Obstetrics and Gynaecology, Jawaharlal Institute of Postgraduate Education and Research, Puducherry , India
    • Other Contributors:
      • Ajith Ananthakrishna Pillai, Additional Professor (Cardiology)
      • Jyoti Baghel, Obstetrics and Gynaecologist

    Dear Editor,

    We thank Güner and colleagues for their comments1 and their interest on our study.1
    It is very common in the low to middle come countries to observe women with more than one pregnancy and the proposed risk stratification score (Devi’s Score) took this scenario into consideration.2 Analyses took into consideration the non-independent nature of the data structure occurring from women having more than one pregnancy and generalized estimating equations were used to produce regression models to account for the clustering occurring due to more than one pregnancy in the same patient.
    Prosthetic heart valve, especially the mechanical heart valves are highly thrombogenic and are associated with complications. On univariate analysis, use of anticoagulation was found to be associated with the adverse cardiac events and since they showed high collinearity with the prosthetic heart valve, it was decided to include prosthetic heart valve in the multivariate analysis. Despite following the guidelines on managing the anticoagulation regimen during pregnancy, we experience multiple challenges in day to day practice. Monitoring and maintaining the International normalised ratio(INR) /prothrombin time within the optimal range during a dynamic hemodynamic, variability in the actual timing in switching over to heparin and the clearly evident risk of thrombo-embolic phenomena during the switch-over time till heparin takes full control are some of the real wor...

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    Conflict of Interest:
    None declared.