Maternal Cardiovascular Emergencies During Pregnancy and the Puerperium: Current Diagnostic Approach and Management

Physiologic changes during pregnancy, advanced maternal age, and cardiovascular comorbidities have been associated with an increased incidence of cardiovascular emergencies (CVEs) manifesting during pregnancy and puerperium, thereby adversely affecting maternal and fetal morbidity and mortality. When a CVE occurs, prompt and high-quality medical management is essential. However, the early diagnosis and management of CVEs in pregnant women are often challenging, as the initial clinical presentation of many of these conditions may mimic common symptoms of a normal pregnancy, resulting in significant diagnostic delays. Furthermore, the administration of optimal medical or interventional therapy in critically ill pregnant women should be carefully considered, balancing maternal well-being and survival against the potential risks that certain medications and interventions may pose to the fetus. Consequently, treatment decisions should involve a multidisciplinary medical team, comprising cardiologists, obstetricians, emergency physicians, anesthesiologists, neonatologists, and other relevant specialists. This review aims to summarize the current diagnostic approaches and management strategies for the most prevalent CVEs encountered during pregnancy, and explore the challenges faced in diagnosing and treating pregnant individuals compared to the non-pregnant population, emphasizing the differences and knowledge gaps in this area.