Perspective:

The following are 10 points to remember from the European Society of Cardiology guidelines on management of cardiovascular diseases during pregnancy:

1. Prepregnancy risk assessment should be performed in all women with congenital or acquired cardiovascular disease.

2. Genetic counseling should be offered to women with congenital heart disease, cardiomyopathy, aortic disease, and genetic malformations associated with congenital heart disease.

3. Vaginal delivery is the preferred mode of delivery for most women with heart disease. Caesarean delivery should be considered in women with severe left ventricular outflow tract obstruction, dilatation of the ascending aorta >45 mm, severe heart failure, Eisenmenger syndrome, or onset of labor while on oral anticoagulants.

4. Prepregnancy relief of valvular pulmonary stenosis should be performed if the peak Doppler gradient is >64 mm Hg.

5. Women with Marfan syndrome should be counseled regarding the recurrence risk in their offspring, as well as the increased risk for aortic dissection during pregnancy. Women with Marfan syndrome and ascending aortic measurement >45 mm should undergo surgical aortic root replacement prior to pregnancy. Women with aortic dilation should undergo echocardiography every 4-8 weeks during pregnancy.

6. Oral anticoagulants are the preferred method of anticoagulation for women with mechanical heart valves during the second trimester and through the 36th week of pregnancy. Anticoagulation for weeks 6-12 and beyond the 36th week is dependent on the clinical situation.

7. Women with heart failure during pregnancy should be treated according to current guidelines for nonpregnant patients, taking into account contraindications to certain drugs during pregnancy.

8. In women with gestational hypertension and subclinical organ damage or symptoms at any time during pregnancy, drug therapy should be initiated at a blood pressure of 140/90 mm Hg. For other circumstances, drug treatment should be considered if systolic blood pressure is ≥150 mm Hg or diastolic blood pressure is ≥95 mm Hg.

9. All women who are pregnant or considering pregnancy should undergo assessment of risk factors for venous thromboembolism (VTE).

10. High-risk patients (those with previous recurrent VTE, unprovoked or estrogen-related VTE, or single previous VTE in the setting of thrombophilia or family history) should undergo antenatal prophylaxis with low molecular weight heparin through 6 weeks of the postpartum period.