Eisenmenger’s syndrome ACC/AHA guidelines for reproduction

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2], Priyamavada Singh, MMBS [[3]]Assistant Editor-In-Chief: Kristin Feeney, B.S. [[4]]

ACC / AHA Guidelines- Recommendations for Reproduction (DO NOT EDIT)

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Class I 1. Women with severe CHD-PAH, especially those with Eisenmenger physiology, and their partners should be counseled about the absolute avoidance of pregnancy in view of the high risk of maternal death, and they should be educated regarding safe and appropriate methods of contraception. (Level of Evidence: B) 2. Women with CHD-PAH who become pregnant should: a. Receive individualized counseling from cardiovascular and obstetric caregivers collaborating in care and with expertise in management of CHD-PAH. (Level of Evidence: C) b. Undergo the earliest possible pregnancy termination after such counseling. (Level of Evidence: C) 3. Surgical sterilization carries some operative risk for women with CHD-PAH but is a safer option than pregnancy. In view of advances in minimally invasive tech- 2428 Circulation December 2, 2008 niques, the risks and benefits of sterilization modalities should be discussed with an obstetrician experienced in management of high-risk patients, as well as with a cardiac anesthesiologist. (Level of Evidence: C) Class III 1. Pregnancy in women with CHD-PAH, especially those with Eisenmenger physiology, is not recommended and should be absolutely avoided in view of the high risk of maternal mortality. (Level of Evidence: B) 2. The use of single-barrier contraception alone in women with CHD-PAH is not recommended owing to the frequency of failure. (Level of Evidence: C) 3. Estrogen-containing contraceptives should be avoided. (Level of Evidence: C) Class IIb 1. Pregnancy termination in the last 2 trimesters of pregnancy poses a high risk to the mother. It may be reasonable, however, after the risks of termination are balanced against the risks of continuation of the pregnancy. (Level of Evidence: C)

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