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Pregnancy Risk mWHO Classification — EECC MCQ

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EasyCongenital Heart Disease (Adult)Pregnancy Risk mWHO ClassificationEECC

A 35-year-old woman with a repaired VSD in infancy presents for pre-pregnancy counselling. Her echocardiogram shows a small residual VSD with Qp:Qs 1.3:1, normal RV and LV function, and no pulmonary hypertension. What is her pregnancy risk?

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Correct answer: B — mWHO class I (low risk) — a small residual VSD with no significant shunt, normal ventricular function, and no PH carries very low maternal cardiac risk during pregnancy; standard obstetric care is appropriate

The 2025 ESC CVD in Pregnancy Guidelines use the modified WHO (mWHO) classification for pregnancy risk in heart disease. mWHO I (very low risk, standard care): small residual VSD without complications, repaired simple lesions (ASD, VSD, PDA) without residual PH or ventricular dysfunction, isolated PVCs. mWHO II: unrepaired ASD, mild-moderate valve disease. mWHO III: mechanical valve, systemic RV, moderate-severe dysfunction. mWHO IV: severe PH, severe systemic ventricular dysfunction, Eisenmenger. This patient with a small residual VSD (Qp:Qs 1.3 = haemodynamically insignificant), normal ventricular function, and no PH is mWHO class I — she can be managed with standard obstetric care without specialist cardiac input beyond pre-pregnancy assessment.

Reference: ESC (2025): CVD in Pregnancy Guidelines