Table 2.

Cardiac risk factors for adverse maternal events; available risk stratification tools: CARPREG II [30], ZAHARA [31], and modified WHO [14]

CARPREG II	ZAHARA	Modified WHO
•Prior cardiac events or arrhythmias •NYHA III–IV functional class or cyanosis •Mechanical valve prosthesis Ventricular dysfunction •High risk left-sided valve disease/LVOT •Pulmonary hypertension •Coronary artery disease •High-risk aortopathy •No prior cardiac intervention first antenatal visit >20 weeks gestation	•Prior arrhythmia •NYHA III–IV functional class •Left heart obstruction (LVOT gradient >50 mmHg, AVA < 1 cm2) •Mechanical valve prosthesis •Moderate-severe subpulmonic or systemic atrioventricular valvular regurgitation •Pre-pregnancy cardiovascular medications •Cyanotic heart disease (either repaired or unrepaired)	Class I: Low risk •Mild/uncomplicated: PS, PDA, MVP •Repaired PDA, ASD, VSD, anomalous pulmonary venous drainage •Isolated atrial/ventricular ectopic beats Class II: Moderate risk •Mild/uncomplicated uncorrected ASD/VSD •Repaired TOF •Most arrhythmias Class II–III: Moderate-high risk •Mild LV dysfunction •HCM •Valvular heart disease not considered class I or IV •Marfan’s with a normal aortic diameter •Bicuspid with aortic dilation <45 mm •Repaired coarctation with bicuspid Class III: High risk •Mechanical valve prosthesis •Systemic RV •Fontan circulation •Unrepaired TOF •Complex congenital heart disease •Marfan with 40–45 mm aortic dilation •Bicuspid with 45-50 mm aortic dilation Class IV: Very high risk, pregnancy not recommended •Severe MS •Severe symptomatic AS •PAH •LVEF <30%, NYHA III–IV functional class •Prior PPCM with residual LV dysfunction •Uncorrected severe coarctation •Marfan with >45 mm aortic dilation •Bicuspid with >50 mm aortic dilation