Referral guidelines and recommendations
1. Preexisting cardiovascular conditions
Individuals with preexisting cardiovascular conditions such as congenital heart disease, valvular heart disease, cardiomyopathy, arrhythmias, diseases of the aorta, inherited disorders such as Marfan Syndrome, etc., should be referred to a cardio-obstetrics clinic. These conditions may require close monitoring and specialized management during pregnancy.
2. History of cardiac surgery or interventions
Patients with a history of prior cardiac surgery such as heart valve replacement or repair, coronary artery bypass grafting, or cardiac device implantation (e.g., pacemaker or defibrillator), may need specialized care to ensure the stability of their cardiovascular status during pregnancy.
3. Severe hypertension
Pregnant individuals with severe hypertension (blood pressure consistently ≥ 160/100 mm Hg) may benefit from evaluation by both an MFM specialist and a cardiologist. Uncontrolled hypertension during pregnancy poses significant risks and requires close monitoring and management.
4. Medication management
Pregnant or preconception individuals who require cardiovascular medications for preexisting conditions should be referred to assess the safety and efficacy of these medications during pregnancy. Adjustments or alternative medications may be needed.
5. Significant cardiac symptoms
Patients experiencing significant cardiac symptoms during pregnancy such as chest pain, palpitations, shortness of breath or syncope (fainting) should be promptly evaluated by both an MFM specialist and a cardiologist to determine the underlying cause and appropriate management.
6. Individualized assessment
Referrals should also be based on individualized assessment, considering the unique medical history and risk factors of each patient. Obstetricians should use their clinical judgment to determine when multidisciplinary care is necessary.
