Modified WHO classification of maternal cardiovascular risk: application
| WHO II-III (depending on individual)-Small increased risk of maternal mortality or moderate increase in morbidity. |
| • Marfan syndrome without aortic dilatation |
| • Aorta < 45 mm in aortic disease associated with bicuspid aortic valve |
| • Repaired coarctation |
| WHO III-Significantly increased risk of maternal mortality or severe morbidity. Expert counselling required. If pregnancy is decided upon, intensive specialist cardiac and obstetric monitoring needed throughout pregnancy, childbirth, and the puerperium. |
| • Aortic dilatation 40–45 mm in Marfan syndrome |
| • Aortic dilatation 45–50 mm in aortic disease associated with bicuspid aortic valve |
| WHO IV-Extremely high risk of maternal mortality or severe morbidity; pregnancy contraindicated. If pregnancy occurs termination should be discussed. If pregnancy continues, care as for class III. |
| • Severe systemic ventricular dysfunction (LVEF < 30%, NYHA III–IV) |
| • Marfan syndrome with aorta dilated > 45 mm |
| • Aortic dilatation > 50 mm in aortic disease associated with bicuspid aortic valve |
| • Native severe coarctation |
LVEF: left ventricular ejection fraction; NYHA: New York Heart Association; WHO: World Health Organization