The European Society of Cardiology (ESC) has published guidelines on the management of cardiovascular diseases during pregnancy, endorsed by several other medical societies. The guidelines aim to assist healthcare professionals in making informed decisions about the care of pregnant women with cardiovascular conditions. Key points include: 1. **Epidemiology**: Cardiovascular diseases (CVD) during pregnancy are becoming more common due to increasing age at first pregnancy and prevalence of risk factors like diabetes, hypertension, and obesity. Hypertensive disorders are the most frequent CVD, occurring in 6-8% of pregnancies, while congenital heart disease is the most common, affecting 75-82%. 2. **Haemodynamic, Haemostatic, and Metabolic Changes**: Pregnancy induces significant changes in the cardiovascular system, including increased blood volume and cardiac output, reduced systemic vascular resistance, and altered glucose and cholesterol homeostasis. These changes can affect drug absorption, excretion, and bioavailability. 3. **Genetic Testing and Counselling**: Genetic testing and counselling are crucial for families with a history of CVD to assess the risk of hereditary conditions in offspring. Fetal echocardiography is recommended from 19-22 weeks to detect congenital heart defects. 4. **Diagnosis**: Various diagnostic tools such as electrocardiography, echocardiography, transoesophageal echocardiography, and exercise testing are used to diagnose CVD during pregnancy. Radiation exposure during diagnostic procedures should be minimized to reduce fetal risk. 5. **Fetal Assessment**: First-trimester ultrasound helps in early detection of multiple pregnancies and malformations. Fetal echocardiography, detailed scanning, and fetal karyotype are essential for suspected fetal anomalies. 6. **Interventions in the Mother**: Percutaneous therapy and cardiac surgery are considered only when medical or interventional treatments fail and the mother's life is at risk. Cardiac surgery is recommended between 13-28 weeks to minimize fetal and maternal complications. 7. **Delivery and Postpartum Care**: Spontaneous labor is preferred for women with normal cardiac function. Induction and caesarean delivery are managed by skilled multidisciplinary teams. Postpartum care includes monitoring for heart failure and thrombo-embolic complications. 8. **Infective Endocarditis**: Prophylaxis is recommended for high-risk procedures. Diagnosis and treatment are similar to non-pregnant patients, but fetal exposure to certain antibiotics must be carefully considered. The guidelines emphasize the importance of interdisciplinary teams, specialized centers, and individualized care to optimize outcomes for both the mother and the fetus.The European Society of Cardiology (ESC) has published guidelines on the management of cardiovascular diseases during pregnancy, endorsed by several other medical societies. The guidelines aim to assist healthcare professionals in making informed decisions about the care of pregnant women with cardiovascular conditions. Key points include: 1. **Epidemiology**: Cardiovascular diseases (CVD) during pregnancy are becoming more common due to increasing age at first pregnancy and prevalence of risk factors like diabetes, hypertension, and obesity. Hypertensive disorders are the most frequent CVD, occurring in 6-8% of pregnancies, while congenital heart disease is the most common, affecting 75-82%. 2. **Haemodynamic, Haemostatic, and Metabolic Changes**: Pregnancy induces significant changes in the cardiovascular system, including increased blood volume and cardiac output, reduced systemic vascular resistance, and altered glucose and cholesterol homeostasis. These changes can affect drug absorption, excretion, and bioavailability. 3. **Genetic Testing and Counselling**: Genetic testing and counselling are crucial for families with a history of CVD to assess the risk of hereditary conditions in offspring. Fetal echocardiography is recommended from 19-22 weeks to detect congenital heart defects. 4. **Diagnosis**: Various diagnostic tools such as electrocardiography, echocardiography, transoesophageal echocardiography, and exercise testing are used to diagnose CVD during pregnancy. Radiation exposure during diagnostic procedures should be minimized to reduce fetal risk. 5. **Fetal Assessment**: First-trimester ultrasound helps in early detection of multiple pregnancies and malformations. Fetal echocardiography, detailed scanning, and fetal karyotype are essential for suspected fetal anomalies. 6. **Interventions in the Mother**: Percutaneous therapy and cardiac surgery are considered only when medical or interventional treatments fail and the mother's life is at risk. Cardiac surgery is recommended between 13-28 weeks to minimize fetal and maternal complications. 7. **Delivery and Postpartum Care**: Spontaneous labor is preferred for women with normal cardiac function. Induction and caesarean delivery are managed by skilled multidisciplinary teams. Postpartum care includes monitoring for heart failure and thrombo-embolic complications. 8. **Infective Endocarditis**: Prophylaxis is recommended for high-risk procedures. Diagnosis and treatment are similar to non-pregnant patients, but fetal exposure to certain antibiotics must be carefully considered. The guidelines emphasize the importance of interdisciplinary teams, specialized centers, and individualized care to optimize outcomes for both the mother and the fetus.