Table 6.

Risk stratification of RHD in pregnancy (22).

Low risk (level I)	Elevated risk (level II)	High risk (level III)	Extremely high risk (level IV): pregnancy is contraindicated and termination considered
- History of ARF but no RHD - Mild asymptomatic RHD - Antenatal visit <20 weeks.	- Mild asymptomatic RHD with antenatal visit >20 weeks - Mild to moderate mitral or aortic regurgitation - Mild mitral stenosis - Bioprosthetic valve or previous mitral balloon commissurotomy - Mildly reduced ejection fraction (>45%) - Not level 3 or 4	- Mechanical valve - Moderate mitral stenosis: mitral valve are 1.5 cm–2 cm2 - Severe asymptomatic aortic stenosis - Severe asymptomatic mitral or aortic regurgitation - Moderately decreased ejection fraction (30%–45%)	- Severe symptomatic mitral stenosis: valve area <1 cm2 - Severe valve lesion with Pulmonary hypertension - Severe symptomatic aortic stenosis - Ejection fraction <30% - NYHA class III/IV