Synopsis
Risk-stratify cardiovascular disease before and during pregnancy, recognise maternal emergencies and coordinate care through a Pregnancy Heart Team.
- Assess known CVD before conception using mWHO 2.0 plus lesion-specific and individual factors.
- Women with mWHO 2.0 class II-III or higher should be evaluated and managed by a Pregnancy Heart Team from pre-pregnancy through postpartum care.
- mWHO 2.0 class IV indicates extremely high maternal and fetal risk; provide expert shared decision-making and discuss alternatives to pregnancy, not coercive care.
Key red flags
Abrupt severe chest/back pain, pulse deficit or neurological signs in an aortopathy is an emergency.
Investigation priorities
Assess chest pain, syncope, palpitations or known arrhythmia.
Management branches
Known or suspected CVD, prior cardiotoxic therapy or important family/genetic cardiac history.
- Define diagnosis, functional status, ventricular/valve/aortic state, rhythm and previous pregnancy outcomes.
- Assign mWHO 2.0 risk and refer class II-III or higher to a Pregnancy Heart Team.
Key medicines
LabetalolFor hypertension in pregnancy, start 100 mg orally twice daily; increase at weekly intervals as needed, up to 100 to 400 mg three times daily, maximum 2.4 g/day.
Nifedipine modified releaseA typical starting dose is 10 mg orally every 12 hours, titrated to a maximum 40 mg every 12 hours for the referenced MR product.