Abstract
Increased prevalence of cardiovascular risk factors (diabetes mellitus, hypertension, obesity) and age at first gestation are the important factors that increase cardiovascular diseases incidence in pregnancy. Assessment of maternal and fetal risk is very important. In World Health Organization class 1, the risk is very low and it is recommended that the cardiologic evaluation be performed once or twice in pregnancy. World Health Organization class 2 patients have low to moderate risk and cardiology consultation is recommended at every trimester. World Health Organization class 3 patients have a high risk, so cardiology consultation is recommended monthly or bi-monthly. Pregnancy is not recommended for World Health Organization class 4 patients. In cases where surgery is necessary the general approach is the same as those who are not pregnant. However, a multidisciplinary approach is needed in pregnant patients. Surgery should be performed independently of the trimester in emergent cases. If an elective intervention is needed and there is no effect on fetus, the surgical procedure should be delayed after birth. If surgery is needed and semi-elective, the optimal time period is indicated as second trimester. The type of anesthesia to be applied is determined according to the type and timing of surgery, maternal physiological changes and teratogenic effects.
 Keywords: Heart disease, pregnancy, preoperative evaluation.
Highlights
Cardiovascular diseases (CVD) are seen in 0,2-4% of pregnancies in western countries [1]
Pregnancy is not recommended for World Health Organization (WHO) class 4 patients, but if pregnant and does not accept termination cardiology consultation is recommended every month or bi-monthly [3]
Women with known coronary artery disease should be evaluated before pregnancy and those with inducible ischaemia should be treated before pregnancy
Summary
Cardiovascular diseases (CVD) are seen in 0,2-4% of pregnancies in western countries [1]. NYHA: New York Heart Association, LVEF: Left ventricular ejection fraction class 2 patients have low to moderate risk and cardiology consultation is recommended at every trimester [3]. Maternal deaths are due to pulmonary hypertensive crisis, pulmonary thrombosis or refractory right heart failure, usually in the last trimester and the first month after birth. This can occur even in patients who have no symptoms or mild symptoms before and during pregnancy. If the patient accepts all risks and decides to continue the pregnancy, it is recommended that these patients be followed up at centers where all treatment options for PAH are available [9]. Vaginal birth can be planned in most cases [10,11]
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