Clinical risk-prediction tools can be used to estimate the likelihood of maternal cardiovascular complications during pregnancy in women with pre-existing heart disease (e.g. ACHD).
Figure source: 1
CARPREG 2
- A higher number of predictors correlates with a higher percentage risk of a cardiac complication.
Figure source: 2
Figure source: 2
Modified WHO (mWHO)
- Class 1 (lower risk) to Class 4 (highest risk)
- Class I: No-to-mild increased risk of mortality/morbidity.
- Class II/III: Intermediate/moderate risk, requiring careful individualized evaluation and monitoring.
- Class IV: Extremely high risk of maternal mortality or severe morbidity; pregnancy is generally contraindicated
ZAHARA
- A weighted risk-scoring tool specifically developed for women with ACHD
Footnotes
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Sharma G, Mehta A, Scott NS. Risk Estimation in Valvular Heart Disease in Pregnancy: An Idea Whose Time Has Come. J Am Coll Cardiol. 2023 Oct 3;82(14):1407-1410. doi: 10.1016/j.jacc.2023.08.022. PMID: 37758435. ↩
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Silversides CK, Grewal J, Mason J, Sermer M, Kiess M, Rychel V, Wald RM, Colman JM, Siu SC. Pregnancy Outcomes in Women With Heart Disease: The CARPREG II Study. J Am Coll Cardiol. 2018 May 29;71(21):2419-2430. doi: 10.1016/j.jacc.2018.02.076. PMID: 29793631. ↩ ↩2