A pregnant female with known cardiac disease presents to you in the first trimester with history of warfarin embryopathy what should be advised now?
Continue warfarin throughout the pregnancy
Replace warfarin with heparin in First trimester
Give acicoumarin
Use LMW heparin
Ans. B. Replace warfarin with heparin in First trimesterRef: Williams Obstetrics, 24'h ed.Warf'arin has a low molecular weight and readily crosses the placenta.Exposure between the 6th and 9th weeks may result in warfarin embryopathy characterized by stippling of the veebrae and femoral epiphyses and by nasal hypoplasia with depression ofthe nasal bone.