What is new in the 2018 ESC guidelines for the management of cardiovascular diseases during pregnancy?

Cardiovascular diseases during pregnancy are the most common causes of pregnancy-associated mortality. Vaginal delivery is the preferred mode of birth in the majority of pregnancies. It is recommended that patients with modified World Health Organization (mWHO) class IV risk are counselled against pregnancy. Patients carrying mWHO II–III, III, and class IV risks should undergo prepregnancy counselling by a multidisciplinary pregnancy heart team to determine a delivery plan and define postpartum care. Specific medications should not be principally withheld in pregnancy but the risk-benefit ratio should be carefully evaluated prior to administration. Beta blockers are recommended during and after pregnancy for congenital long QT syndrome and catecholaminergic polymorphic ventricular tachycardia. Low molecular weight heparin is the ideal substance for prophylaxis and treatment of venous thromboembolism in pregnancy under weekly monitoring of anti-factor Xa activity.