ACOG ACOG 2019 Guidelines American College of Obstetrics and Gynecology Practice Bulletin CVD in pregnancy Cardiovascular Diseases in pregnancy Managing heart disease in pregnancy Managing heart diseases after pregnanacy post-partum management of heart diseases in pregnancy

1. Heart Disease in
Pregnancy
ACOG Guidance 2019

3. CVD from pre-pregnancy to post-partum
ManagementDiagnosisScreening

4. Recommendation 1
The four key risk factors linked to cardiovascular disease-related
maternal mortality are:
1. Race/ethnicity, with non-Hispanic black women having a 3.4-fold
increased risk for dying from cardiovascular disease-related
pregnancy complications
2. Age
3. Hypertension
4. Obesity

5. Recommendation 2
All women should be assessed for CVD in the prenatal and
postpartum period using the California CVD Tool Kit
algorithm. According to what California learned from its
experience with their mothers, 88% of women who died
would have been identified as high risk requiring further
evaluation and referral had this new screening algorithm
been used.

6. Recommendation 3
Women with known heart disease should see a cardiologist
prior to pregnancy and receive pre-pregnancy counselling.

7. Recommendation 4
• Patients determined to have moderate and high-risk CVD
should be managed during pregnancy, delivery, and postpartum
in a medical centre that is able to provide a higher level of
care
• Including a multidisciplinary Pregnancy Heart Team that
includes obstetric providers, maternal-fetal medicine
specialists, and cardiologists and anesthesiologists at a
minimum
• Collaboration between providers, particularly ob-gyns and
cardiologists, is key.

8. Recommendation 5
• The postpartum period is a time of increased risk for
cardiovascular disease-related complications. The elevated
risk is both in the immediate period and can extend from six
months to a year
• A follow-up visit with a primary care clinician or cardiologist
should occur within seven to 10 days for all women with
hypertensive disorders and seven to 14 days for all women
with heart disease or cardiovascular disorders.

9. Concluding remarks
• Pregnancy is a natural stress test
• The cardiovascular system must undergo major changes to its
structure to sustain tremendous increases in blood volume
• That’s why it is critical to identify the risk factors beforehand so
that a woman’s care can be properly managed throughout the
pregnancy and a detailed delivery plan can be developed through
shared decision making between the patient and provider.