Transthoracic Echocardiographic Assessment of the Heart in Pregnancy—a position statement on behalf of the British Society of Echocardiography and the United Kingdom Maternal Cardiology Society

Curtis, Stephanie L.; Belham, Mark; Bennett, Sadie; James, Rachael; Harkness, Allan; Gamlin, Wendy; Thilaganathan, Baskaran; Giorgione, Veronica; Douglas, Hannah; Carroll, Aisling; Kitt, Jamie; Colebourn, Claire; Ribeiro, Isabel; Fairbairn, Sarah; Augustine, Daniel X.; Robinson, Shaun; Thorne, Sara A.

doi:10.1186/s44156-023-00019-8

Table 6 Suggested frequency of echocardiography surveillance during and after pregnancy [27, 39, 40]

From: Transthoracic Echocardiographic Assessment of the Heart in Pregnancy—a position statement on behalf of the British Society of Echocardiography and the United Kingdom Maternal Cardiology Society

Condition	During pregnancy	Post-partum	Level of evidence and strength of recommendation
Valvular disorders^a	As early as possible if not performed pre-pregnancy
Stenotic lesions	Mild AS:
	Once mid gestation only	3–5 years	IIaC
	Mild MS:
	Once 2nd and 3rd trimester	3–5 years	IIaC
	Moderate AS:
	Once 2nd and 3rd trimester and prior to delivery	12 months	IIaC
	Severe AS:
	4–8 weekly depending on symptoms, and prior to delivery	Pre-discharge, then 3 months	IC
	Moderate and severe MS:
	4–8 weekly depending on symptoms, and prior to delivery	Pre-discharge, then 3 months	IC
Regurgitant lesions	Mild AR/MR, moderate PR/TR:
	Once mid gestation	As per usual follow-up	IIaC
	Moderate AR/MR, severe PR/TR:
	Once 2nd and 3rd trimester	6 months	IIaC
Tissue prostheses	Severe: S Severe AR/MR:
	8 weekly depending on symptoms	Pre-discharge, then 6 months	IIaC
Mechanical prostheses	As for native valve disease	Pre-discharge, then 1–2 months	IC
	4 weekly if functionally normal		IC
Cardiomyopathy
Dilated cardiomyopathy	4–8 weekly, increasing to 1–4 weekly, if LVEF <40%	Pre-discharge, then 4–8 weeks, depending on ventricular function/recovery	IC
Hypertrophic cardiomyopathy	If symptomatic, systolic dysfunction, impaired diastolic function with raised filling pressure or obstruction, 4 weekly, otherwise once only	Pre-discharge, then 4-8 weeks if complicated or obstruction, otherwise 3–6 months	IIaC
ARVC	4–8 weekly, depending on RV function	Pre-discharge, then 4 weeks, if impaired RV function, otherwise 3–6 months	IIaC
Previous peripartum cardiomyopathy , with recovered LV function	End first trimester and end second trimester	Prior to discharge and one month after delivery	IC
Inherited aortopathies	4–12 weekly, depending on clinical scenario, as determined by the pregnancy heart team^b	Pre-discharge, then 4–12 weeks, depending on clinical scenario	IC
Congenital heart disease^c
ASD with right heart dilatation, unrepaired	Once, not required if small	As per usual follow-up	IIaC
Fallot	If impaired RV function 4–8 weekly, otherwise once	Pre-discharge and 4–8 weeks if impaired RV function, otherwise 3–6 months	IIaC
TGA with systemic right ventricle	4–8 weekly, depending on clinical scenario	Pre-discharge, then 4–8 weeks	IIaC
Fontan	8 weekly, depending on clinical scenario/once	Pre-discharge only impaired ventricular function, otherwise 3–6 months	IIaC
Coronary artery disease	Once only, if no residual ventricular dysfunction	As per usual follow up	IIC
Hypertensive disorders of pregnancy	Only if suspicion of heart failure, or coarctation of the aorta	Not usually indicated	IC
Pulmonary arterial hypertension	4 weekly, increasing to 2–4 weekly, depending on RV function, as determined by the pregnancy heart team	Prior to discharge and at 4–8 weeks	IC

ARVC arrhythmogenic right ventricular cardiomyopathy, AR aortic regurgitation, AS aortic stenosis, ASD atrial septal defect, EF ejection fraction, LV left ventricular, MR mitral regurgitation, MS mitral stenosis, PR pulmonary regurgitation, RV right ventricular, TGA transposition of the great arteries, TR tricuspid regurgitation
^aDegree of valve stenosis/regurgitation is based on pre-pregnancy scan. Post-partum follow up of mild and moderate valve disease can, in general, be as per BSE guidelines. In more severe disease, the pregnancy or simply the passage of time may have progressed the disease and earlier follow up is advised
^bFrequency depends on the risk of dilatation, which is related to the aortic diameter, the underlying condition and the family history of dissection
^cDictated by ventricular function and valve disease

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