ABSTRACT
What you do in pregnancy and when you do it are governed primarily by maternal considerations; however, given a reasonably hemodynamically stable gravida, fetal considerations can modify when you do it. A management schema that augments maternal jeopardy to enhance fetal outcome necessitates valid patient participation and consultation. Once the criteria for valve replacement have been met, and if age is consistent with a reasonable probability of a good fetal outcome, the tendency has been to deliver the fetus prematurely in order to avoid intraoperative risks to the fetus. Burstein et al. (1985) have reported successful cardiopulmonary bypass with subsequent aortic valve replacement immediately after an emergency cesarean section in a case of acute gonococcal endocarditis complicated by fetal distress at 30 weeks’ gestation as a result of maternal cardiovascular decompensation. When surgery and/or the postoperative course require
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effective anticoagulation, the risk of internal bleeding to the fetus as well as to the mother is introduced.
