The new ESC guidelines place a strong focus on cardiovascular diseases in pregnancy, emphasizing the importance of dedicated care for this vulnerable patient group and encouraging the future establishment of multidisciplinary “pregnant heart teams.”

They highlight that pulmonary embolism (PE) presents with the same symptoms as in non-pregnant women, but diagnosis should aim to reduce CT pulmonary angiography by using clinical probability assessment (YEARS criteria), D-dimer testing with pregnancy-adapted thresholds, and venous ultrasound.

In suspected venous thromboembolism (VTE), therapeutic low-molecular-weight heparin (LMWH) should be started immediately, continued if confirmed, and maintained for at least six weeks postpartum (total about three months). LMWH or vitamin K antagonists (VKAs) are safe during breastfeeding. For the first time, the guidelines also recommend considering catheter-directed treatment in cases of severe pulmonary embolism.

For delivery, no planning is needed under prophylactic anticoagulation, but women on therapeutic LMWH require a planned delivery with prior discontinuation of anticoagulation to avoid spontaneous labour under full anticoagulation.