MATERNAL CARDIOVASCULAR DISEASES

Cardiovascular disease (CVD) remains a leading cause of maternal morbidity and mortality world-wide and increasingly intersects with contemporary obstetric care as more women with congenital and acquired heart disease reach reproductive age. Physiological adaptations of pregnancy, including expanded blood volume, increased cardiac output, and decreased systemic vascular resistance, can unmask latent disease or destabilize pre-existing pathology, with additional hemodynamic stress con-centrated in labor and the early postpartum period. A structured, preconception strategy anchored in multidisciplinary counseling and validated risk frameworks (e.g., the modified WHO classification and disease-specific scores) enables optimization of comorbidities, medication reconciliation, and in-dividualized delivery planning. Disease-specific considerations are pivotal. Among congenital lesions, risks range from low (repaired simple shunts) to prohibitive (cyanotic physiology, Fontan circulation, Eisenmenger), warranting tailored surveillance and counseling. Valvular disease poses distinct chal-lenges: fixed obstructions tolerate increased flow poorly, while regurgitant lesions may be better ac-commodated yet remain vulnerable in borderline ventricular function; patients with mechanical valves require nuanced anticoagulation strategies coordinated across disciplines. Peripartum cardiomyopathy necessitates pregnancy-compatible heart-failure regimens and vigilant postpartum monitoring; se-lected cases may benefit from bromocriptine with anticoagulation. Arrhythmias often intensify under gravid physiology, demanding prompt rate/rhythm control and correction of precipitants. Ischemic heart disease, including pregnancy-associated spontaneous coronary artery dissection, requires timely reperfusion strategies and careful antithrombotic use. Pulmonary hypertension remains WHO class IV in most precapillary forms, with high maternal risk and a premium on expert, individualized man-agement. Across conditions, the intrapartum–postpartum window is a peak-risk interval necessitating meticulous hemodynamic control, judicious analgesia, and early escalation pathways. This chapter synthesizes contemporary principles into a practical guide spanning risk stratification, disease-spe-cific management, delivery planning, anticoagulation and analgesia considerations, and longitudinal follow-up, with the aim of improving maternal and neonatal outcomes while supporting informed reproductive decision-making.