Vaginal delivery is recommended in most women with CVD.Guideline rec
Class ILevel BRec Table 3 · §4.5 · p.4487
Delivery planner
Inputs
Output
Routine induction of labour prior to 39 weeks is not recommended in women with stable CVD.Guideline rec
Class IIILevel CRec Table 3 · §4.5 · p.4487
Systemic antibiotic prophylaxis may be considered for delivery in women at high risk.Guideline rec
Class IIbLevel CRec Table 3 · §4.5 · p.4487
- c Patients with prosthetic cardiac valves or a history of infective endocarditis, or cardiac transplant patients with residual valve defects.
An individualized delivery plan should be made that covers the needs for induction of labour, labour management, delivery, and post-partum surveillance, in shared decision-making with the pregnant women. This delivery plan should be widely accessible to the patient, her partner, and relevant health professionals, and should be placed in the patient’s (electronic) health record.
No class printed§4.5, printed p4486 [TXT]
Vaginal delivery is associated with less blood loss and lower risk of infections and venous thromboembolism and should be advised for most women. Planned caesarean section does not confer any advantage over planned vaginal delivery in terms of maternal outcomes and may be associated with adverse foetal outcomes.
No class printed§4.5.3, printed p4486 [TXT]
Pregnant women with CVD are more likely to have comorbidities and experience adverse events during delivery than those without CVD, and require additional monitoring and care. Any maternal benefit of early term delivery (from 37 weeks 0 days to 38 weeks 6 days of gestation) should be weighed against the increased likelihood of adverse foetal outcomes. Induction of labour between 39 and 40 weeks reduces the risk of emergency caesarean section by 12% and the risk of stillbirth by 50% in women without CVD. The benefit is likely to be greater for women with CVD who have higher rates of obstetric complications. In the absence of maternal or foetal indications for early birth, induction of labour before 39 weeks should be reserved for obstetrical indications.
No class printed§4.5.1, printed p4486 [TXT]
- §4.5.3 prints 'high-risk aortopathy (mWHO 2.0 class III)'; Table 6 also places some aortopathy in class IV. The text is never used to set a class.
- For urgent delivery on anticoagulants the protamine window differs between Figure 5 (24 h) and the text (12 h); use the Figure 5 walker, where both are shown and flagged [REVIEW].
- Figure 17 prints the pacing-dependency advice inside the ICD box. With 'pacemaker' selected the two ICD-programming items are hidden and the pacing-dependency item is kept with that note; nothing else is inferred.
Educational summary of the 2025 ESC Guidelines. It does not replace clinical judgement or local protocol.