Table 2.

Recommendations for the management of women with hypertrophic cardiomyopathy before and during pregnancy

Before pregnancy

Assessment of symptoms

Echocardiography (LV systolic and diastolic function, LVOT obstruction, mitral regurgitation)

Exercise testing

Start medication (beta-blocker, preferably metoprolol) when symptomatic

Risk assessment and counselling

Genetic counselling

During pregnancy

Follow-up each trimester (low-risk) or monthly/bimonthly (increased risk)

Clinical assessment, echocardiography

Continue beta-blocker or start when symptomatic

Prompt treatment of atrial fibrillation

Delivery

Vaginal delivery appropriate

Blood pressure and rhythm monitoring

Avoid Swan-Ganz catheter

Monitor preload echocardiographically when necessary

Cautious use of epidural or spinal anaesthesia

Replace fluid loss, avoiding overhydration

Oxytocin only as slow iv infusion

Clinical observation for at least 24 h post-delivery