ESC Guidelines on the Management of Cardiovascular Diseases During Pregnancy

Regitz‐Zagrosek, Vera; Lundqvist, Carina Blomström; Borghi, Claudio; Cífková, Renata; Ferreira, Rafael; Foidart, Jean‐Michel; Gibbs, J. Simon R.; Gohlke-Baerwolf, Christa; Görenek, Bülent; Iung, Bernard; Kirby, Michael; Maas, Angela H.E.M.; Nihoyannopoulos, Petros; Pieper, Petronella G.; Presbitero, Patrizia; Roos‐Hesselink, Jolien W.; Schaufelberger, Maria; Seeland, Ute; Torracca, Lucia

doi:10.1016/j.rec.2011.11.005

Cited by 242 publications

(758 citation statements)

References 249 publications

(453 reference statements)

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“…The data that are available demonstrate that pregnancy is generally well tolerated [11,12]; however, a subset of patients do experience significant complications [10].…”

Section: Risk Assessmentmentioning

confidence: 99%

“…To identify patients at increased risk a pre-conceptual review is recommended [9,11,13]. The ESC guidelines on the management of cardiovascular disease during pregnancy advise that a risk assessment is performed using the modified World Health Organization (WHO) classification.…”

Section: Risk Assessmentmentioning

confidence: 99%

“…The ESC guidelines on the management of cardiovascular disease during pregnancy advise that a risk assessment is performed using the modified World Health Organization (WHO) classification. HCM is considered a WHO class II or III risk lesion, implying there is a moderate risk of morbidity in most women and potentially a significant risk for some [11]. In saying that, pregnancy is contraindicated in a minority of women, for example if there is significant impairment of systolic function (LVEF<40 %) or if there is severe symptomatic LVOT obstruction.…”

Section: Risk Assessmentmentioning

confidence: 99%

“…To aid the pregnancy risk assessment, all women should be assessed clinically and undergo echocardiography and exercise tolerance testing [9,11]. Salient features to note on echo are measures of diastolic function, systolic function, localisation and severity of hypertrophy, outflow tract gradients at rest and with provocation, cavity dimensions and gradients, SAM and degree of mitral regurgitation and left atrial dimensions.…”

Section: Risk Assessmentmentioning

confidence: 99%

“…As per the ESC guidelines for the management of cardiovascular diseases during pregnancy [11], women with HCM who are in WHO class II should be reviewed by a cardiologist with clinical examination and echo assessment each trimester. For women in WHO class III more frequent follow-up, monthly or bimonthly, is warranted.…”

Section: Management During Pregnancy and Deliverymentioning

confidence: 99%

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Pregnancy in women with hypertrophic cardiomyopathy

Pieper

Walker

2012

Neth Heart J

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Hypertrophic cardiomyopathy (HCM) is increasingly being diagnosed in pregnant women. Women with HCM generally tolerate pregnancy well. The risk is however higher in women who are symptomatic before pregnancy or in those with severe left ventricular outflow tract obstruction. The incidence of arrhythmias does not appear to be increased during pregnancy and maternal mortality is low. Prior to conception, women with HCM should have a risk assessment as well as genetic counselling. During pregnancy beta-blockers should be continued and the judicious use of diuretics may be required to treat symptoms of dyspnoea. A vaginal delivery with regional anaesthesia is usually appropriate. Women should be managed by a specialist multidisciplinary team.

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“…The data that are available demonstrate that pregnancy is generally well tolerated [11,12]; however, a subset of patients do experience significant complications [10].…”

Section: Risk Assessmentmentioning

confidence: 99%

Section: Risk Assessmentmentioning

confidence: 99%

Section: Risk Assessmentmentioning

confidence: 99%

Section: Risk Assessmentmentioning

confidence: 99%

Section: Management During Pregnancy and Deliverymentioning

confidence: 99%

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Pregnancy in women with hypertrophic cardiomyopathy

Pieper

Walker

2012

Neth Heart J

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A 38-Year-Old Woman With Worsening Dyspnea After Giving Birth

2020

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Pre‐eclampsia and long‐term cardiac dysfunction: A review of asymptomatic cardiac changes existing well beyond the post‐partum period

Thayaparan

Said

Löwe

et al. 2019

Australas J Ultrason Med

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Background: Pre-eclampsia is a disease of pregnancy characterised by the manifestations of multi-organ dysfunction. The recent use of transthoracic echocardiography in the assessment of women with pre-eclampsia has allowed the detection of cardiac systolic and diastolic dysfunction in the acute phase. Women with a history of pre-eclampsia also have increased lifelong risks of cardiovascular disease and mortality that persists well beyond the post-partum period. These developments raise the possibility that pre-eclampsia may be an early marker of cardiovascular disease and the potential role for echocardiography in guiding the detection and management of this. This review aims to summarise the existing evidence of echocardiographic cardiac assessment of women with a history of pre-eclampsia performed more than 12 weeks post-partum. Methods: A systematic search of PubMed and OVID EMBASE databases was performed to identify studies featuring assessment of cardiac function performed after 12 weeks post-partum in women with a history of pre-eclampsia. Studies without post-partum cardiac assessment or with other documented causes for cardiomyopathy were excluded. Results: Thirteen studies were identified that measured cardiac function by transthoracic echocardiography between 6 months and 18 years following a pregnancy complicated by pre-eclampsia. Common findings across the studies were of increased diastolic dysfunction, increased left ventricular mass index (LVMI) and concentric hypertrophy in women with a history of preeclampsia, as compared to women with uncomplicated pregnancy histories. This was predominantly seen in those with a history of early or preterm pre-eclampsia. Conclusions: Women with a history of early or preterm pre-eclampsia have an increased prevalence of diastolic dysfunction. This review demonstrates that the cardiac dysfunction associated with previous pre-eclampsia is quantifiable and persistent. Progression of heart failure from asymptomatic to symptomatic stages carries a fivefold increase in mortality. The use of echocardiography could detect cardiac dysfunction in the asymptomatic stage and guide more intensive risk factor modification in these women.

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ESC Guidelines on the Management of Cardiovascular Diseases During Pregnancy

Cited by 242 publications

References 249 publications

Pregnancy in women with hypertrophic cardiomyopathy

Pregnancy in women with hypertrophic cardiomyopathy

A 38-Year-Old Woman With Worsening Dyspnea After Giving Birth

Pre‐eclampsia and long‐term cardiac dysfunction: A review of asymptomatic cardiac changes existing well beyond the post‐partum period

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