Cardiac disease in pregnancy contraindications to pregnancy

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Contraindications to pregnancy

Special Scenarios:

I. Pre-existing Cardiac Disease:
Congenital Heart Disease
Repaired Congenital Heart Disease
Pulmonary Hypertension
Rheumatic Heart Disease
Connective Tissue Disorders
II. Valvular Heart Disease:
Mitral Stenosis
Mitral Regurgitation
Aortic Insufficiency
Aortic Stenosis
Mechanical Prosthetic Valves
Tissue Prosthetic Valves
III. Cardiomyopathy:
Dilated Cardiomyopathy
Hypertrophic Cardiomyopathy
Peripartum Cardiomyopathy
IV. Cardiac diseases that may develop During Pregnancy:
Arrhythmias
Acute Myocardial Infarction
Hypertension

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Absolute and relative contraindications to pregnancy include severe pulmonary arterial hypertension; severe fixed valve stenoses (AS,MS,PS,HOCM, coarctation; Class III or IV congestive heart failure with a left ventricular ejection fraction of < 40%; a history of peripartum cardiomyopathy; a dilated aorta such as in Marfan's syndrome with an aortic arch >40-45 mm; and severe cyanosis.

Contraindications to Pregnancy

Conditions in Which Pregnancy is NOT ADVISED

  • Class III or IV CHF, EF <40%
  • Prior peripartum cardiomyopathy
  • Dilated or unstable aorta
  • Aorta >45 mm: strongly discourage pregnancy
  • Aorta is <40 mm: the risk is not as high, but there is no safe aortic diamter.
  • Aorta 40-45 mm: Evaluate the rate of aortic growth and family history. Even after repair, Marfan's syndrome patients remain at risk of dissection in the residual aorta.

References

Cardiology