Complex congenital heart conditions call for complex care in pregnancy

• Defining which patients are at increased risk in pregnancy.
• Physiological adaptations of pregnancy, the puerperium, and the postpartum period, with an emphasis on hemodynamic changes.
• Assessment and evaluation in the preconception and early prenatal periods.
• Pregnancy management, including appropriate testing.
• Medications in pregnancy, including a table of common cardiac drugs and their pregnancy categories and lactation risks.
• Breakdown of suggested prenatal care by trimester.
• Intrapartum care, including indications for fluid management, ECG and hemodynamic monitoring, and management of the second stage of delivery.
• Postpartum care, with attention to the very rapid increase in blood volume and concomitant leap in stroke volume and cardiac output.
• Considerations when choosing contraceptive method.
• Cardiac complications seen in pregnancy, including arrhythmias, managing mechanical valves and anticoagulation, heart failure, and cyanosis.
• Indications for and risks associated with interventional therapies during pregnancy.
• Detailed discussion of management of pregnancy for women with specific lesions.

None of the members of the writing committee for the scientific statement had relevant disclosures. Dr. Foley and Dr. Kay reported no disclosures. Dr. Norton reported that she has received research funding from Natera and Ultragenyx.

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