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Pregnancy and valve disease

Authors
Candice Silversides, MD, MS, FRCPC
Jacob A Udell, MD, MPH, FRCPC
Section Editors
Heidi M Connolly, MD, FASE
Charles J Lockwood, MD, MHCM
Deputy Editor
Susan B Yeon, MD, JD, FACC

INTRODUCTION

Hemodynamic changes during pregnancy, including increases in heart rate, stroke volume, and cardiac output (see "Maternal cardiovascular and hemodynamic adaptations to pregnancy"), can result in cardiac decompensation in women with valvular heart disease (VHD). Stenotic valve lesions are generally less well tolerated during pregnancy compared with regurgitant lesions. The risk of complications varies according to the type and severity of the underlying VHD.

This topic will discuss risk assessment and management of native valve disease during pregnancy. Evaluation and management of pregnant women with bicuspid aortic valve, with mitral stenosis, with Marfan syndrome, and with prosthetic heart valves are discussed separately. (See "Pregnancy in women with a bicuspid aortic valve" and "Pregnancy in women with mitral stenosis" and "Pregnancy and Marfan syndrome" and "Management of pregnant women with prosthetic heart valves" and "Use of anticoagulants during pregnancy and postpartum".)

PRECONCEPTION OR INITIAL EVALUATION

Timing — When possible, women should undergo preconception assessment and counseling so that they are able to make informed pregnancy decisions. For women who have not had preconception counseling, a complete risk evaluation should occur at the first antenatal visit.

In developed healthcare systems, women are typically aware of significant health conditions in advance of pregnancy; however, occasionally, pregnancy unmasks a previously unrecognized valve lesion. This latter scenario may be more frequent in developing healthcare systems, for instance in women with undiagnosed rheumatic mitral stenosis who first present during pregnancy. (See "Natural history, screening, and management of rheumatic heart disease", section on 'Pregnancy'.)

In general, there are many health outcome benefits to seeking preconception counseling. Women with valvular heart disease (VHD) should have a preconception evaluation by a cardiologist with expertise in pregnancy and VHD. Risk assessment for women with VHD should involve a focused evaluation of the risk for the mother and baby. Many women with heart disease are unaware of the risks of pregnancy, and patient education is an important aspect of the preconception assessment [1]. (See "The preconception office visit".)

                            

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Literature review current through: Nov 2016. | This topic last updated: Mon Feb 22 00:00:00 GMT+00:00 2016.
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