Maternity Medicine Network
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Cardiology
mWHO I | mWHO II | mWHO II-III | mWHO III | mWHO IV | |
---|---|---|---|---|---|
Diagnosis (if otherwise well and uncomplicated) |
Small or mild – pulmonary stenosis – patent ductus arteriosus – mitral valve prolapse Successfully repaired simple lesions (atrial or ventricular septal defect, patent ductus arteriosus, anomalous pulmonary venous drainage) Atrial or ventricular ectopic beats isolated |
Unoperated atrial septal or ventricular defect Repaired tetralogy of Fallot Most arrhythmias (supraventricular arrhythmias) |
Mild left ventricular impairment (EF >45%) Hypertrophic cardiomyopathy Native or tissue valve disease not considered WHO I or IV (mild mitral aortic stenosis) Marfan or other HTAD syndrome without aortic dilatation Aorta <45 mm in bicuspid aortic valve pathology Repaired coarctation Atrioventricular septal defect Turners Syndrome All channelopathies (event rate not applicable) |
Moderate left ventricular impairment (EF 30-45%) Previous peripartum cardiomyopathy without any residual impairment of left ventricular function Systemic right ventricle with good or mildly decreased ventricular function Fontan circulation. If otherwise the patient is well and the cardiac condition uncomplicated Unrepaired cyanotic heart disease Other complex heart disease Moderate mitral stenosis Severe asymptomatic aortic stenosis Moderate aortic dilatation Ventricular tachycardia |
Pulmonary arterial hypertension (managed in Sheffield PH service) Severe left ventricular dysfunction (EF <30% or NYHA class III-IV) Previous peripartum cardiomyopathy with any residual left ventricular impairment Severe mitral stenosis Severe symptomatic aortic stenosis Systemic right ventricle with moderate or severely decreased ventricular function Severe aortic dilatation Vascular Ehlers-Danlos Severe (re)coarctation Fontan with any complication Mechanical valve |
Risk | No detectable increased risk of maternal mortality and no/mild increased risk in morbidity | Small increased risk of maternal mortality or moderate increase in morbidity | Intermediate increased risk of maternal mortality or moderate to severe | Significantly increased risk of maternal mortality or severe | Extremely high risk of maternal mortality or severe |
Maternal cardiac event rate |
2.5-5% | 5.7-10.5% | 10-19% | 19-27% | 40-100% |
Pre-pregnancy Counselling |
Optional- local unit | Yes-local unit | Yes- local unit | Yes: expert counselling required |
Yes: expert counselling required |
Care during pregnancy | At the Local hospital. If there are concerns, or a lack of expertise or timely review in the local hospital, refer to the obstetric cardiology clinic at the local MMC forreview or advice. | At the Local hospital. If there are concerns, or a lack of expertise or timely review in the local hospital, refer to the obstetric cardiology clinic at the local MMC for review or advice. | Refer to the Obstetric Cardiology Clinic at the local MMC for MDT consideration about where antenatal care and delivery is most appropriately located irrespective of where they usually attend for their cardiac care. For some women, delivery may be appropriate in their local unit. | Refer to the Obstetric Cardiology Clinic at the local MMC for MDT consideration about where antenatal care and delivery is most appropriately located irrespective of where they usually attend for their cardiac care. |
Refer to the Obstetric Cardiology Clinic at their local MMC for regional MDT discussion and decision about transfer of antenatal care and delivery. Pulmonary Hypertension cases discussed in MMC MDT -managed in Sheffield PH Service |
Minimal follow-up visits during pregnancy |
Once or twice | Once per trimester | Bimonthly | Monthly or Bimonthly | Monthly |
Location of delivery | Local hospital | Local Hospital or Individualised assessment after MDT review | Individualised assessment after MDT review | Expert centre for pregnancy and cardiac disease as decided at MMC MDT review | Expert centre for pregnancy and cardiac disease as decided at MMC MDT or Regional MDT |
- pulmonary stenosis
- patent ductus arteriosus
- mitral valve prolapse
- Successfully repaired simple lesions (atrial or ventricular septal defect, patent ductus arteriosus, anomalous pulmonary venous drainage) Atrial or ventricular ectopic beats isolated
Unoperated atrial septal or ventricular defect
Repaired tetralogy of Fallot
Most arrhythmias (supraventricular arrhythmias)
Moderate left ventricular impairment (EF 30-45%)
Previous peripartum cardiomyopathy without any residual impairment of left ventricular function
Systemic right ventricle with good or mildly decreased ventricular function
Fontan circulation. If otherwise the patient is well and the cardiac condition uncomplicated
Unrepaired cyanotic heart disease
Other complex heart disease
Moderate mitral stenosis
Severe asymptomatic aortic stenosis
Moderate aortic dilatation
Ventricular tachycardia
Pulmonary arterial hypertension (managed in Sheffield PH service)
Severe left ventricular dysfunction (EF <30% or NYHA class III-IV)
Previous peripartum cardiomyopathy with any residual left ventricular impairment
Severe mitral stenosis
Severe symptomatic aortic stenosis
Systemic right ventricle with moderate or severely decreased ventricular function
Severe aortic dilatation
Vascular Ehlers-Danlos
Severe (re)coarctation Fontan with any complication
Mechanical valve
Refer to the Obstetric Cardiology Clinic at their local MMC for regional MDT discussion and decision about transfer of antenatal care and delivery.
Pulmonary Hypertension cases discussed in MMC MDT -managed in Sheffield PH Service
Gastroenterology and Liver
- Active disease despite treatment
- Biologics
- Corticosteroids
- Peri-anal disease
- Pouch/stoma
- Not responding to treatment
- Recurrent disease
- Hypertriglyceridaemia
- IR/surgical intervention