Cardiovascular Diseases during Pregnancy (Management of) Guidelines

2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy

Table of Contents

Abbreviations and acronyms

1. Preamble

2. Introduction

2.1 Why do we need new Guidelines on the management of cardiovascular diseases in pregnancy?

2.2 New format of the Guidelines

2.3 Why these Guidelines are important

2.4 Methods

2.5 What is new?

3.General considerations

3.1 Epidemiology

3.2 Physiological adaptations to pregnancy

3.3 Pre-pregnancy counselling

3.4 Cardiovascular diagnosis in pregnancy

3.5 Genetic testing and counselling

3.6 Foetal assessment

3.7 Interventions in the mother during pregnancy

3.8 Timing and mode of delivery: risk for mother and child

3.9 Infective endocarditis

3.10 Methods of contraception and termination of pregnancy, and in vitro fertilization

3.11 RecommendationsCongenital heart disease and pulmonary hypertension

4. Congenital heart disease and pulmonary hypertension

4.1 Introduction

4.2 Pulmonary hypertension and Eisenmenger’s syndrome

4.3 Specific congenital heart defects

4.4 Recommendations

5. Aortic diseases

5.1 Maternal and offspring risk.

5.2 Specific syndromes.

5.3 Management

5.4 Recommendations

6.Valvular heart disease

6.1 Stenotic valve lesions

6.2 Regurgitant lesions

6.3 Atrial fibrillation in native heart valve disease

6.4 Prosthetic valves

6.5 Mechanical prostheses and anticoagulation

6.6 Recommendations

7. Coronary artery disease

7.1 Aetiology

7.2 Presentation and diagnosis

7.3 Management

7.4 Pharmacotherapy

7.5 Intervention

7.6 Pre-existing CAD

7.7 Labour and delivery

7.8 Recommendations

8. Cardiomyopathies and heart failure.

8.1 Peripartum cardiomyopathy

8.2 Dilated cardiomyopathy.

8.3 Management of heart failure during and after pregnancy

8.4 Hypertrophic cardiomyopathy

8.5 Recommendations

9. Arrhythmias

9.1 Introduction

9.2 Maternal risk

9.3 Obstetric and offspring risk

9.4 Supraventricular tachycardia

9.5 Atrial fibrillation and atrial flutter

9.6 Ventricular tachycardia

9.7 Bradyarrhythmias

9.8 Interventions.

9.9 Recommendations

10.Hypertensive disorders

10.1 Diagnosis and risk assessment

10.2 Definition and classification of hypertension in pregnancy

10.3 Prevention of hypertension and pre-eclampsia

10.4 Management of hypertension in pregnancy

10.5 Delivery

10.6 Prognosis after pregnancy

10.7 Recommendations.

11. Venous thrombo-embolic disease during pregnancy and the puerperium

11.1 Epidemiology and maternal risk

11.2 Risk factors for pregnancy-related venous thrombo-embolism and risk stratification

11.3 Prevention of venous thrombo-embolism.

11.4 Management of acute venous thrombo-embolism

11.4.1 Pulmonary embolism.

11.5 Recommendations

12. Drugs during pregnancy and breastfeeding

12.1 General principles

12.2 US Food and Drug Administration classification

12.3 Internet databases

12.4 Pharmaceutical industry

12.5 Recommendations

13.Gaps in the evidence

14. Key messages

15. ‘What to do’ and ‘what not to do’ messages from the Guidelines

16. Appendix

Supplementary material

References