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  • Pregnancy.

  • History of heart disease.

  • Symptoms and signs of heart disease.

  • Echocardiographic or other objective evidence of heart disease.


Cardiovascular complications occur in up to 4% of pregnancies and cause up to 27% of U.S. pregnancy-related deaths. The incidence is increasing due in part to (1) improved life expectancy of women with congenital heart disease who can pursue pregnancy and (2) a trend toward older maternal age. The unique hemodynamic changes associated with pregnancy make diagnosis and management of heart disease in pregnant patients a challenge to the physicians, who must consider not only the patient but also the risks to the fetus. This gap in medical progress has driven the increased appreciation and standardization of multidisciplinary approaches to managing cardiovascular disease in pregnancy with emerging Cardio-Obstetric programs worldwide. In addition, pregnancy risk scores, including the CARPREG II (Cardiac Disease in Pregnancy), mWHO (modified World Health Organization), and ZAHARA [Zwangerschap bij Aangeboren HARtAfwijking (Pregnancy in Women With Congenital Heart Disease)], have evolved over the past 2 decades. (Table 33–1)

Table 33–1.Pregnancy Risk Scores

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