A blueprint of an integrated cardio-obstetric care pathway for women with intermediate- to high-risk cardiovascular disease in pregnancy and postpartum.

INTRODUCTION/BACKGROUND: Women with pre-existing cardiovascular disease (CVD) face elevated maternal and fetal risks and implementing existing cardio-obstetric guidelines remains challenging. A previous integrated preconception care pathway for this population has been developed. As a next step, the aim of the current work was to develop a practical, expert-based integrated care pathway (ICP) for women with intermediate to high CVD risk during antepartum and postpartum periods. METHODS: The integrated obstetric cardiology pathway was developed via a review of international cardiac and obstetric guidelines, and was complemented based on clinical experience by an interdisciplinary expert panel, including health care professionals from Antwerp University Hospital and Erasmus MC, incorporating clinical experience and consensus meetings to establish a standardised, evidence-based care model. RESULTS: Coordinated care, and inclusive, patient-centred communication are important context factors. Different healthcare provider specialties address preconception assessment separately. Key ICP steps include the first visit, second and early third trimester visits to a specialised clinic, birth planning, and postpartum follow-up. At the first visit, it is important to confirm the pregnancy. Then, patients should see a dedicated cardiologist, undergo medication review with substitution for pregnancy-safe options if needed, and receive psychosocial assessment. The interdisciplinary team should (re)assess risk, plan follow-up, and arrange genetic counselling when indicated. In the second trimester, routine obstetric care should incorporate symptom monitoring and education on warning signs. In the late second to early third trimester, a birth plan should be defined, covering delivery methods, (duration of) haemodynamic monitoring, pain management, and medication or fluid restrictions. Postpartum care includes planning close monitoring for CVD complications, cardiovascular assessment at predefined timepoints, and ongoing (psychosocial) symptom surveillance. CONCLUSION: This expert-developed ICP offers a structured, practical approach to managing intermediate- to high-risk CVD in pregnancy and postpartum, supporting consistent, evidence-based cardio-obstetric care to improve maternal outcomes.