Modified World Health Organization classification of maternal cardiovascular risk

	mWHO I*	mWHO II*	mWHO II-III^¶	mWHO III^Δ	mWHO IV^Δ
Diagnosis	Mild PS Small PDA	ASD Repaired TOF Arrythmias	BAV Ao <45 mm	Cyanotic coronary heart disease mechanical valve	Severe PH LVEF <30%
Risk	Not increased	Small	Intermediate	Significant	Extremely high
Maternal CV event rate	2.5 to 5%	5 to 10%	10 to 19%	20 to 27%	40 to 100%
Visits during pregnancy	1 to 2	Once per trimester	Bimonthly	Monthly or bimonthly	Monthly

WHO: World Health Organization; mWHO: modified WHO; PS: pulmonary stenosis; PDA: patent ductus arteriosus; ASD: atrial septal defect; TOF: tetralogy of Fallot; BAV: bicuspid aortic valve; PH: pulmonary hypertension; LVEF: left ventricular ejection fraction; CV: cardiovascular.

* Care during pregnancy and delivery should be performed at a local hospital.

¶ Care during pregnancy should be done at a local hospital, and delivery should be performed at a referral hospital.

Δ Care during pregnancy and delivery should be performed at an expert center for pregnancy and cardiovascular disease.

Adapted from: Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, et al. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J 2018; 39:3165.

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Modified World Health Organization classification of maternal cardiovascular risk