gynecology and obstetrics
Heart Disease in Pregnancy
Key Points
Pregnancy may not be advisable for women with certain high-risk heart disease (eg, pulmonary hypertension, coarctation of the aorta if uncorrected or accompanied by an aneurysm, Marfan syndrome with aortic root diameter of > 4.5 cm, severe symptomatic aortic stenosis, severe mitral stenosis, bicuspid aortic valve with ascending aorta > 50 mm, a single ventricle with impaired systolic function, cardiomyopathy, NYHA class III or IV heart failure). Treat heart failure and arrhythmias during pregnancy as for nonpregnant patients, except avoid certain medications (eg,warfarin, ACE inhibitors, ARBs, aldosterone antagonists, thiazide diuretics, certain antiarrhythmics such asamiodarone). Treat most pregnant patients who have atrial fibrillation with standard or low molecular weightheparin. Indications for endocarditis prophylaxis for pregnant patients with a structural heart disorder are the same as those for other patients. 