Keywords: anticoagulation; embryopathy; mechanical heart valve; pregnancy EN anticoagulation embryopathy mechanical heart valve pregnancy 465 478 14 07/26/23 20230801 NES 230801 INTRODUCTION Evidence is limited regarding the prevalence and optimal management of pregnancy in individuals with mechanical heart valves (MHVs). The MDT should document a delivery plan that should include the anticoagulation regimen, analgesic options during labour, anaesthetic options for an operative intervention (e.g. caesarean birth), haemodynamic monitoring, the uterotonic agents to be utilised and the recommended postpartum anticoagulation regimen following childbirth. If a prophylactic dose of LMWH has been administered to the patient after interrupting therapeutic anticoagulation for 24 h, then the recommended time interval for placement of neuraxial labour analgesia is 12 h. Although pregnancy is associated with a pro-thrombotic state and significant risk of valve thrombosis, the risk of thrombosis after pausing anticoagulation over a brief period is likely to be low; however, the risk of bleeding is high in the peripartum period and is likely to be exacerbated using very early postpartum therapeutic anticoagulation. [Extracted from the article]