الفهرس 
Title : Assessment of maternal and neonatal outcome in rheumatic heart disease pregnant women /
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Abstract
Besides its high prevalence, rheumatic heart disease in developing countries is characterized by the occurrence of severe VHD (valvular heart disease) at a younger age than in developed countries. Mitral stenosis, which affects women more frequently than men, is relatively common among women of childbearing age with VHD. Mitral stenosis and/or regurgitation were the most common types of valvular pathologies (63%), followed by aortic valve disease (23%) (roos-hesselink et al. 2013). Little is known about pregnancy-related outcomes after different types of valve replacement (VR). Significant cardiovascular physiological changes occur during pregnancy that can affect prosthetic performance. Plasma volume and cardiac output increase progressively from the first to the third trimester of gestation, with a significant decrease in systemic vascular resistance, resulting in a hyperdynamic circulation (clapp and capeless 1997). In addition, pregnancy is associated with a hypercoagulable state, which places women with mechanical valve prostheses at higher risk of thrombo- embolism and prosthetic valve thrombosis (Cerneca et al. 1997). Furthermore, warfarin, which crosses the placental barrier, is associated with teratogenicity in up to 6% of fetuses (Iturbe-Alessio et al. 1986). Although the use of heparin is not associated with teratogenicity, it remains less efficient in preventing prosthesis-related thromboembolic