| Risk assessment and reduction |
- Discuss pregnancy risks (cardiac and obstetric; maternal and fetal)
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- Any necessary medication modifications (based on safety profile during pregnancy and lactation)
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- Any required cardiac intervention prior to conception
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- Consider referral to cardio-obstetric center: consult with the pregnancy heart team, including cardiology and maternal fetal medicine
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- Discuss contraception options for those women who are planning pregnancy in the future
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| Antepartum management |
- Clinical surveillance throughout pregnancy, with frequency of visits based on severity of disease and risk profile
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- Transthoracic echocardiographic surveillance during pregnancy
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| Peripartum and postpartum management |
- Discuss timing (induced versus spontaneous onset of labor), site of delivery (community hospital versus referral center), route of delivery (vaginal, with caesarean reserved for fetal/obstetric indications), use of regional anesthesia (generally recommended), possible need for cardiac monitoring
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- Need for postpartum follow-up
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- For women contemplating another pregnancy, reevaluate pregnancy risks at 6 months postpartum
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