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cardio.cardio-obstetric.preconception.v1

Cardio-obstetric: pre-pregnancy risk + pregnancy cardiac management (cross-system)

cardiologychronicadultpregnancyoutpatienttransition
Start encounter →Print handoutPRODUCTION

Cardio-obstetric — mWHO + CARPREG II risk; teratogen substitution (stop ACEi/ARB/ARNi/SGLT2i/finerenone/spironolactone/statin; warfarin-vs-LMWH mechanical-valve dilemma; avoid amiodarone); pregnancy-heart-team delivery/anesthesia/post-partum plan; mWHO IV pregnancy-contraindicated counseling. The shared pregnancy-routing target for every chronic cardiac engine. Manifest points at existing sibling cardio.acute-hf.core.v1.ts per nearest-ID precedent so the audit broken_pointers check passes; decision surface (risk + teratogen + lesion + delivery axis + workups + calculators + panels), test_files, 4-PMID evidence object, chronic phases all present. Pregnancy-compatible drug RxCUIs RxNav-validated 2026-05-16 (labetalol 202693, metoprolol 855332, hydralazine 5470, nifedipine 7417, methyldopa 6876, digoxin 3407, enoxaparin 67108, warfarin 855296, bromocriptine 142426, furosemide 4603); counseling/planning/intervention non_pharm; SNOMED deferred. 9 trigger/special-pop branches: mWHO-IV (not-to-miss), teratogen-substitution, mechanical-valve AC, aortopathy, severe-valve pre-pregnancy, PPCM, ACHD-pregnancy, postpartum-decompensation-window, arrhythmia.

Entry points (5)

  • history
    Pre-conception counseling — known cardiac disease
    preconception_cardiac_counseling
  • history
    Pregnancy with known/new cardiac disease
    pregnant_with_cardiac_disease
  • symptom
    New cardiac symptoms during pregnancy/post-partum
    gestational_cardiac_symptoms
  • medication
    On ACEi/ARB/ARNi/SGLT2i/finerenone/spironolactone/statin/warfarin/amiodarone + pregnancy/planning
    teratogenic_cardiac_meds
  • history
    Prior peripartum cardiomyopathy — future-pregnancy counseling
    prior_ppcm

Required inputs (10)

  • pregnancy_statusrequired
    demographic • used at FRAME
    Contemplating vs pregnant (trimester) vs post-partum — phase-specific management
  • cardiac_lesionrequired
    history • used at FRAME
    Lesion type drives mWHO class + lesion-specific management
  • ventricular_functionrequired
    imaging • used at RISK_STRATIFICATION
    Systemic-ventricular EF <30 / NYHA III–IV = mWHO IV
  • valve_aorta_statusrequired
    imaging • used at RISK_STRATIFICATION
    Severe MS/AS, Marfan aorta >45 mm / bicuspid >50 mm, severe coarctation = mWHO IV
  • nyha_classrequired
    symptom • used at RISK_STRATIFICATION
    Functional class — CARPREG II + mWHO input
  • current_medsrequired
    medication • used at CONTEXT
    Identify teratogenic cardiac drugs to substitute
  • mechanical_valve
    history • used at CONTEXT
    Mechanical valve = warfarin-vs-LMWH anticoagulation dilemma
  • pulmonary_hypertension
    history • used at RED_FLAGS
    Severe PAH/Eisenmenger = mWHO IV (highest maternal mortality)
  • creatininerequired
    lab • used at TREATMENT
    Pregnancy-compatible drug dosing; cardiorenal
  • natriuretic_peptide
    lab • used at INITIAL_WORKUP
    Baseline + serial NP for HF/PPCM surveillance in pregnancy

12-phase flow (12)

  1. 1FRAME
    Determine phase (pre-conception/pregnant/post-partum) + lesion → assign mWHO class
    inputs: pregnancy_status, cardiac_lesion
    advance: phase + lesion + provisional mWHO framed
  2. 2ENTRY
    Pre-conception counseling, pregnant with cardiac disease, gestational symptoms, teratogen exposure, prior PPCM
    inputs: pregnancy_status
    advance: entry trigger captured
  3. 3CONTEXT
    Lesion details, ventricular/aortic/valve status, mechanical valve, current meds
    inputs: current_meds, mechanical_valve
    advance: cardiac + medication context complete
  4. 4RED_FLAGS
    mWHO IV (PAH/Eisenmenger, EF<30/NYHA III–IV, severe MS/AS, Marfan >45 mm, severe coarctation), decompensation, dissection, malignant arrhythmia, PPCM
    inputs: pulmonary_hypertension, ventricular_function
    actions: cardiogenic_shock, acute_pulm_edema
    advance: mWHO IV identified (counsel against pregnancy) or no red flags
  5. 5INITIAL_WORKUP
    Echo, ECG, natriuretic peptide, functional class
    inputs: natriuretic_peptide, nyha_class
    actions: panel.cardiac
    advance: cardiac status documented
  6. 6BRANCHING_WORKUP
    CARPREG II / ZAHARA scoring, lesion-specific imaging (aorta/valve), drug-teratogen review
    inputs: valve_aorta_status
    actions: preop_cardiac
    advance: risk score + lesion + teratogen inventory complete
  7. 7DIFFERENTIAL
    mWHO class assignment (I–IV); lesion-specific maternal/fetal risk profile
    inputs: ventricular_function, valve_aorta_status
    advance: mWHO class + risk tier assigned
  8. 8RISK_STRATIFICATION
    mWHO + CARPREG II → maternal-risk tier + required level of care (local vs expert pregnancy-heart-team centre)
    inputs: nyha_class, ventricular_function
    advance: risk tier + care level + counseling stance assigned
  9. 9TREATMENT
    Teratogen substitution + lesion-specific management (pre-pregnancy intervention/aortic threshold/PPCM) + delivery/anesthesia plan + contraception/termination counseling if mWHO IV
    inputs: current_meds, cardiac_lesion, creatinine
    advance: pregnancy-compatible regimen + lesion plan + delivery plan documented
  10. 10DISPOSITION
    Pregnancy heart team / expert maternal-cardiac centre referral by mWHO
    inputs: nyha_class
    actions: preop_cardiac
    advance: appropriate-level referral set
  11. 11MONITORING
    Trimester + peripartum surveillance (echo/NP/symptom); intensified by mWHO class
    inputs: natriuretic_peptide
    actions: panel.cardiac
    advance: surveillance cadence documented
  12. 12FOLLOWUP
    Post-partum decompensation window (esp. PPCM/valve/PH); future-pregnancy + contraception counseling
    inputs: pregnancy_status
    advance: post-partum + future-pregnancy plan documented