There has been recent increase in number of women undergoing echocardiography, apparently for ruling out any hidden heart disease. In some parts of India it reached epidemic proportions that raised some concern. The folllowing post was written about this recently in this site , which evoked mixed reactions.
Now, in 2025 the new ESC guidelines for pregnancy and heart disease is released. Let us see what it says about this . Being pregnant never makes a women eligible for an echocardiogram. (No guidelines ever supported it ) It is true, cardio vascular morbidity is increasing in pregnancy as we have moved on from traditional maternal risks. May be, the new guidelines suggest we can do Echocardiography more liberally , but definitely not as routine .Please note ,it is still backed up by that mystery 1-C evidence base.
The three key words used in the guideline are
In any pregnant women
1.Unexplained cardiac symptoms
2 New cardio vascular sign
3. New cardio vascular symptom
What about women with pre-existing heart disease ?
I think, they could have included these indication in the same table. Any pregnant women with a known history of past heart disease, with or without symptoms, must undergo a detailed Echo evaluation to know the current hemodynamic status. Also, Echo should be used liberally in all in all women at high risk for cardiac morbidity (Like PIH, GDM, Obesity elderly primi, etc)
Final message
Echocardiography is simple and accurate methodology to rule out structural heart disease in pregnancy. It has great potential to detect hidden heart disease. But, it should be judiciously. Routine echocardiography to rule out a cardiac condition is becoming a non professional fad in many parts of our country What is more ironic is this practice is rampant in low and middle income countries where financial resources are scarce. It is a clearly a pathway to avoid .Let us follow the guidelines as for as possible.
Postamble
What could be the new symptom or sign in pregnancy ?
1. Mild exertional dyspnea , which was not there before . 2.A grade 1 systolic murmur across the RVOT or rumble in AV valve ? This will make every other patient (Then may be 50% of 25 million pregnancy that occur in India every year) .Still there is room to misuse the guidelines .I would argue the committee to , address the critical importance of clinical assessment and these guidelines should instill confidence to ignore physiological symptoms.
Counterpoint( Expert comment in real time from an Obstetrician)
A leading obstetrician, practicing In Chennai says she is sorry to say this. It seems many of us have lost confidence in clinical skills. In this technological era, we are unable to rely only on clinical opinion. So, echo is an easy way out. Also we are worried about legal aspects of potential miss.
I don’t know where the problem lies. In fact, one of my colleague cardiologist said , though they are confident enough to diagnose a normal heart in pregnancy by clinical means ,the referring doctor (obstetrician) often Insists an Echo.
We also know how a routine Echo might detect some innocuous entities like MVPS, a trivial TR, a dilated ventricle, a mild pericardial effusion, a small PFO, a bicuspid aortic valve, and create huge anxieties in our patients. Still… we do it to relieve ours at the cost of patients.
Reference
https://academic.oup.com/eurheartj/article-lookup/doi/10.1093/eurheartj/ehaf193
Dr.S.Venkatesan MD 