Mode of delivery for pregnant women with heart disease

In Western industrialised countries, 0.2%–4% of all pregnancies are complicated by cardiovascular diseases, and maternal heart disease is the major cause of maternal death during pregnancy.1 While in the Western world, congenital heart disease is the most frequent cardiovascular disease present during pregnancy, in non-Western countries, rheumatic valvular disease dominates.1 As the number of adults with congenital heart disease is increasing due to the great achievements in the treatment of congenital heart defects over the last decades, the prevalence of women with cardiac disease reaching adulthood and contemplating pregnancy is also increasing.2 But, still, cardiac disease in pregnancy remains a relatively ‘evidence-sparse’ field.3 Randomised controlled trials are absent,2 which results in controversy regarding optimum care. One field of intense debate is the mode of delivery, with caesarean section (CS) and vaginal delivery as contenders. Cardiologists and obstetricians often hold very firm views with regard to the superiority of one form of delivery over another.3 The current guidelines of the European Society of Cardiology about pregnancy in cardiac disease recommend that the preferred mode of delivery is vaginal, while …