Patient handout

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

PRODUCTION

1. Your condition

This handout is for cardio-obstetric: pre-pregnancy risk + pregnancy cardiac management (cross-system). Your care team identified this based on: pre-conception counseling — known cardiac disease.

Other reasons your team may use this plan: pregnancy with known/new cardiac disease; new cardiac symptoms during pregnancy/post-partum; on acei/arb/arni/sglt2i/finerenone/spironolactone/statin/warfarin/amiodarone + pregnancy/planning.

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
mWHO + CARPREG II/ZAHARA risk stratification + pre-conception counseling (incl. contraception/termination counseling if mWHO IV)	—	—	—	2018 ESC Pregnancy — mWHO drives care level; mWHO IV = pregnancy contraindicated → effective contraception + (if pregnant) termination discussion

Plan: Cardio-obstetric — mWHO risk + teratogen substitution + lesion/delivery planning (2018 ESC Pregnancy; CARPREG II)

3. When to call your provider

Contact your care team if any of the following happen:

mWHO IV pregnant → urgent expert counseling (termination discussion) — 2018 ESC Pregnancy
Decompensation / PPCM / dissection → ED + acute pathway — 2018 ESC Pregnancy
Post-partum decompensation → intensified monitoring/admission — 2018 ESC Pregnancy

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

mWHO IV (severe PAH/Eisenmenger, systemic-ventricular EF<30/NYHA III–IV, severe MS, severe symptomatic AS, Marfan aorta >45 mm / bicuspid >50 mm, native severe coarctation, prior PPCM with residual dysfunction) — pregnancy CONTRAINDICATED: effective contraception; if pregnant, expert counseling incl. termination — 2018 ESC Pregnancy(life-threatening)
On ACEi/ARB/ARNi/SGLT2i/finerenone/spironolactone/statin (or amiodarone) + pregnancy/planning — substitute pregnancy-compatible regimen immediately — 2018 ESC Pregnancy
Mechanical valve in pregnancy — warfarin (most thromboprotective, teratogenic 1st trimester) vs LMWH (safer fetus, valve-thrombosis risk) shared decision; switch near delivery — 2018 ESC Pregnancy(life-threatening)
Marfan/Loeys-Dietz/bicuspid/Turner aortopathy — dissection risk peaks peripartum; aortic imaging each trimester; pre-pregnancy surgery at lower threshold; BB throughout — 2018 ESC Pregnancy
Severe MS / severe symptomatic AS — pre-pregnancy balloon valvotomy / intervention to reduce maternal risk — 2018 ESC Pregnancy
Peripartum cardiomyopathy (current or prior with residual dysfunction) — bromocriptine + anticoagulation + the four foundational heart-failure medications (postpartum); prior PPCM = high recurrence/mWHO escalation — BOARD; 2018 ESC Pregnancy(life-threatening)
ACHD in pregnancy (TOF/Fontan/transposition/shunts) — lesion-specific mWHO + expert ACHD-obstetric care; Fontan/Eisenmenger very high risk — 2018 ESC Pregnancy
Early post-partum (auto-transfusion + fluid shifts) — highest decompensation window for valve/HF/PPCM/PH — intensified monitoring, planned admission for high-risk — 2018 ESC Pregnancy

5. Follow-up

Post-partum decompensation window (esp. PPCM/valve/PH); future-pregnancy + contraception counseling

6. Sources

Guideline: 2018 ESC Pregnancy Guideline (Regitz-Zagrosek) + CARPREG II (Silversides); BOARD (bromocriptine PPCM)