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| Hypertensive disorder of pregnancy (HDP) | Ischemic heart disease in pregnancy (IHD) | Vulvar heart disease in pregnancy | Stroke in pregnancy |
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| Precounseling to avoid pregnancy until control of hypertension or during pregnancy advise following below | Prepregnant council to delay pregnancy after treatment of IHD. If unexpected pregnant, then the following management | Pregnancy should be avoided in severe mitral and aortic valve disease. If unexpected pregnant, then the following management | Precounseling to control hypertension who has a previous history of preeclampsia |
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| Investigation | | | |
| Urine test for proteinuria. | Positive stress ECG, MRI, and exercise testing evidence for IHD and recommendation coronary angiography, if clinically indicated. | Clinical and ECG knowledge are required sequentially for a pregnant woman to know the condition of valvular heart disease. The percutaneous valve intervention is the best treatment for those who are not responding to the medical therapy. | MRI images are considered an optimal modality during pregnancy, in case of missing timely taken MRI, then angiography CT and also perfusion CT can be chosen as a guide for proper interventional therapies. |
| Ophthalmoscopic examination. |
| Blood values |
| USG |
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| Risk factors | | | |
| Hypertension, obesity, and family history of diabetes | Hypertension and preeclampsia are strongly associated with AMI. | Rheumatic fever is a most common | Preeclampsia, eclampsia |
| Mechanical heart valves |
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| Pregnancy management | | | |
| Close follow-up | Close follow-up | Close follow-up | Closely monitoring. Common drugs used: labetalol, atenolol, methyldopa, nifedipine, warfarin, and heparin (low molecular weight), and direct oral anticoagulants. |
| Medical therapy: Nifedipine, methyldopa, labetalol, and hydralazine | Medical therapy: antiplatelet therapy, nitrates, beta-blockers, inotropes, and oxygen
Intervention: PCI and cardiac surgery | Medical therapy for heart failure or arrhythmias
Balloon valvuloplasty or surgical valve replacement |
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| Delivery | | | |
| Vaginal delivery with control of hypertension | Normal vaginal delivery unless cardiac and obstetrician indication. Continuous maternal cardiac monitoring. Continuous electronic fetal monitoring. Emergency cesarean section prior to cardiac surgery if needed. | If possible, vaginal delivery is preferred. Cesarean section is chosen when there is risk to the mother or fetus. Early delivery for clinical and hemodynamic worsening. | Vaginal delivery is the best approach if there is no obstetric contraindication. |
| Emergency cesarean section if required |
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| Complication | | | |
| Stroke, hypertension, and cardiac disease are responsible for the development of preeclampsia or eclampsia during pregnancy and also in postpartum | Cardiac arrest, heart failure, and ventricular tachycardia | Pulmonary edema, atrial arrhythmias, stroke, and heart failure | Reversible cerebral vasoconstriction syndrome can cause both ischemic and hemorrhagic stroke and the risk of cerebral venous sinus thrombosis (CVST). Long-term disability |
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| Follow-up | | | |
| The utility of subclinical vascular measurements, such as cerebral or peripheral vasomotor reactivity, carotid intimal medial thickness, coronary calcification, or clinical and biochemical biomarkers, is needed to identify women with a history of preeclampsia at increased risk of future stroke. | Maternal cardiac monitoring for at least 48 hours after delivery | Hemodynamic monitoring at least 24 hours postpartum | Counseling and cardiovascular screening of women who have a past history of preeclampsia. As well as correction of the other vascular risk factors. |
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