The preconception visit allows patients with a variety of medical conditions to discuss the risks and benefits of pregnancy while formulating plans to optimize their medical comorbidities to reduce maternal-fetal morbidity and mortality.
| Absolute contraindications to pregnancy | • Pulmonary arterial hypertension • Peripartum cardiomyopathy with residual LV dysfunction • Heart failure with LVEF <30% • Severe coarctation • Severe mitral stenosis • Severe symptomatic aortic stenosis • Severe aortic dilation (eg, Marfan syndrome) | | --- | --- | | Management | • Recommend against pregnancy at preconception counseling visit • If pregnant, discuss abortion; if abortion declined, regular |
Pregnancy is contraindicated during breast cancer treatment due to teratogenic agents such as chemotherapy and radiation.
Although reproductive decisions are personal choices, the potential complications of pregnancy must be addressed to prevent harm. However, when pregnancy poses a substantial risk to the life of the mother, directive counseling—a type of counseling employed when there is only 1 safe, reasonable, and clearly superior evidenced-based option—should be performed. In these cases, the primary duty of the physician is to act in the best interest of the patient (ie, beneficence) and avoid potentially harmful adverse effects (ie, nonmaleficence), even if it conflicts with patient autonomy. Therefore, the most appropriate course is to not recommend pregnancy in this patient, even if the patient understands the risk and still desires pregnancy. If the patient becomes pregnant and declines abortion, regular cardiology follow-up is indicated.
Cardiovascular contraindications to pregnancy (same as mentioned above)