There are different anticoagulation methods recommended for pregnant women with mechanical flaps. The method we recommend is anticoagulation with warfarin throughout, keeping the anticoagulation index at the required low limit, as smooth as possible, and replacement with heparin before labor. Although there is some risk of teratogenicity, it reduces the risk of bleeding and maximizes the safety of the mother. Of course, this is only one approach, and implementation requires a detailed treatment plan with your physician specializing in obstetrics and gynecology and cardiac surgery. The use of anticoagulants during pregnancy and childbirth is indeed a more problematic issue. Prior to cardiac surgery, we generally recommend a bioprosthetic valve for women with fertility requirements who need a valve replacement. Although biologic valves have a certain life expectancy and require a second surgery for younger patients, we believe that the risk of a second surgery is more manageable and acceptable to the patient than the risk of placental bleeding, intrauterine hemorrhage, and fetal malformations during pregnancy and childbearing, which may be associated with the use of warfarin. The use of bioprosthetic flaps has no effect on later pregnancy and childbirth, provided that pregnancy occurs after warfarin is discontinued 3-6 months after the procedure. There is no effect on fertility in men taking warfarin.