Management of Valvular Heart Disease in Pregnancy: Challenges, Risk Stratification, and Multidisciplinary Approaches

Advancements in medicine and surgery have led to an increasing number of women with valvular heart disease (VHD) reaching reproductive age and pursuing pregnancy. VHD, which may be congenital or acquired, accounts for a significant proportion of heart diseases in pregnant women, with rheumatic heart disease being the predominant cause globally, especially in developing countries. Pregnancy-induced hemodynamic changes can exacerbate preexisting valvular conditions, leading to complications such as heart failure, arrhythmia, and adverse fetal outcomes. Management of pregnant women with VHD requires a comprehensive, multidisciplinary approach involving preconceptional counseling, risk stratification, and careful monitoring throughout pregnancy. Risk assessment models, including CARPREG II, ZAHARA II, mWHO, and the DEVI score, help identify high-risk patients and guide management strategies. Specific challenges arise in patients with mechanical prosthetic valves due to the need for anticoagulation therapy, which must be carefully managed to minimize risks to both mother and fetus. The delivery plan should be tailored to the severity of the valvular disease, with careful consideration of the mode of delivery and the need for anticoagulation management during labor and postpartum. Preconception counseling is crucial in informing women of the potential risks and helping guide family planning decisions. This paper highlights the importance of early diagnosis, tailored treatment, and a multidisciplinary approach to reduce maternal and fetal morbidity and mortality in pregnant women with valvular heart disease.