Pregnancy and its complications after cardiac valve replacement

The outcome of 64 pregnancies in 40 women who conceived after cardiac valve replacement were reviewed. Fetal wastage was 53.2% (25/47) in coumarin administered pregnancies, 36.4% (4/11) using heparin and 16.7% (1/6) without anticoagulants. Two fetal malformations were noted in coumarin administered pregnancies. There were two maternal deaths. Maternal morbidity due to antenatal bleeding, atrial fibrillation, thromboembolic episodes and cardiac failure were found to be 20.0% (8/40), 17.5% (7/40), 10.0% (4/40) and 10.0% (4/40), respectively.

Stress-induced release of cortisol and prolactin during dilatation and curettage under general and local anesthesia

Comparison of the effect of general and local anesthesia on serum prolactin and cortisol concentrations in response to the stress of dilatation and curettage revealed that short surgical procedures under general anesthesia resulted in no significant change in mean serum cortisol and in a significant decrease in mean serum prolactin. By contrast, short surgical procedures under local anesthesia resulted in a significant increase in serum prolactin and cortisol concentrations. Our findings support the importance of using general anesthesia during dilatation and curettage.