Pregnancy in CHD: delivery decisions, complications, and length of stay

Survivorship among individuals with CHD has expanded, bringing more pregnancies into routine care. In this issue, a single-centre retrospective case-control study (162 CHD deliveries vs 321 controls) reports higher composite maternal cardiac events (8.6 vs 3.4%; risk ratio 2.5, 95% CI 1.2-5.4), greater use of operative or assisted delivery, and an approximately doubled length of stay. Modified WHO class correlates with length of stay but not with discrete cardiac events; maternal age independently predicts cardiac events; rates of pre-eclampsia are lower in CHD. These findings support first-trimester cardio-obstetric triage, standardised delivery bundles, and capacity planning that uses risk class to anticipate monitoring needs, with routine 6-12-week postpartum review. Limitations include selection, era differences, and modest sample size. Overall, anticipatory planning and disciplined intrapartum decision-making remain key to safe, resource-aware care for pregnant women with CHD.