Cardiology

Criteria for referral to the North East and North Cumbria Maternal medicine network has been developed based upon NHS England Maternal medicine service specification (appendix 2) , the mWHO risk stratification (appendix 3) and in consultation with lead clinicians around the region.

Women should be risk stratified using appendix 1 and referred through to the MMC for timely access to specialist care via NENC connect (click here).

Clinic timetable

MMC Cardiology Obstetric leads- Dr K Hodson & Dr S Williams

Cardiologist- Dr K Jansen & Dr J Rybicka

Joint Obstetric & Cardiology clinics run on Thursday afternoons at Freeman Hospital, Outpatient department C.

? Regional Unit- JCUH

Obstetric Consultant-

Cardiologist- Dr P Brown

Contact details

Cardiology Secretaries: 0191 21 37484

Adult Congenital Heart Nurse Specialist:

Appendix 1. North East and North Cumbria Maternal Medicine Network cardiology conditions for consideration for referral for maternal medicine opinion or transfer of care.

Appendix 2. mWHO risk stratification

Appendix 2. NHS England Referral criteria

Clinical resources

2025 ESC Guidelines for the management of cardiovascular disease and pregnancy

ESC Guidelines on Cardiovascular Diseases during Pregnancy (Management of)

NICE Guidance

Recommendations | Intrapartum care for women with existing medical conditions or obstetric complications and their babies | Guidance | NICE

Patient information leaflets

Planning pregnancy with a heart condition- British Heart Foundation

Pregnancy and your heart: why it’s important to plan ahead – BHF

Planning pregnancy with aortic disease- Aortic Disease Awareness

Planning Pregnancy with Aortic Disease

Pregnancy with a heart condition -Leeds Hospital

Pregnancy and heart conditions

Heart condition and sexual health & Contraception

Pregnancy with a heart condition – Scottish Obstetric Cardiology Network

Appendix 2

	m WHO I	m WHO II	m WHO II-III	m WHO III	m WHO IV
Diagnosis	Small or mild - pulmonary stenosis - patent ductus arteriosus - mitral valve prolapse Successfully repaired simple lesions atrial or ventricular septal defect - patent ductus arteriosus -anomalous pulmonary venous drainage Atrial or ventricular ectopic beats isolated	Unoperated atrial septal or ventricular defect Repaired tetralogy of Fallot Most arrhythmias (supraventricular arrhythmias)	Mild left ventricular impairment (EF >45%) . Hypertrophic cardiomyopathy Native or tissue valve disease not considered WHO I or IV (mild mitral aortic stenosis) Marfan or other HTAD syndrome without aortic dilatation Aorta Aorta <45 mm in bicuspid aortic valve pathology Repaired coarctation Atrioventricular septal Defect Turners Syndrome All channelopathies (event rate not applicable)	Moderate left ventricular impairment (EF 30-45%). Previous peripartum cardiomyopathy without any residual impairment of left ventricular function Systemic right ventricle with good or mildly decreased ventricular function. Fontan circulation. If otherwise the patient is well and the cardiac condition uncomplicated Unrepaired cyanotic heart disease Other complex heart disease Moderate mitral stenosis Severe asymptomatic aortic stenosis Moderate aortic dilatation Ventricular tachycardia	Pulmonary arterial hypertension (Severe left ventricular dysfunction (EF <30%) Previous peripartum cardiomyopathy with any residual left ventricular impairment Severe mitral stenosis Severe symptomatic aortic stenosis Systemic right ventricle with moderate or severely decreased ventricular function Severe aortic dilatation Vascular Ehlers-Danlos Severe (re)coarctation Fontan with any complication Mechanical valve

Category A (Local Hospital planned care- refer to MDT if opinion needed)	Category B (Referral to MDT for discussion and advice)	Category C (Refer to MDT for consideration of MMC led care)
Mild pulmonary stenosis	Mild reduced left ventricular ejection fraction (>45%)	Pulmonary hypertension
Small/repaired patent ductus arteriosus	Hypertrophic cardiomyopathy with no high-risk features	Left ventricular ejection fraction <45%
Mitral valve prolapse	Repaired aortic coarctation	Severe aortic stenosis
Repaired atrial septal defect	Mild mitral stenosis	Systemic right ventricle
Repaired ventricular septal defect	Mild-moderate aortic stenosis	Fontan
Isolated atrial or ventricular ectopic beats	Other valve lesions not listed in A or C	Previous peripartum cardiomyopathy
Postural tachycardia syndrome (PoTS)	Atrioventricular septal defect	Ventricular arrhythmia
	Repaired tetralogy of Fallot	Mechanical valve
	Supraventricular arrhythmias	Moderate-severe mitral stenosis
	Turner syndrome without aortic dilatation	Aortic dilatation
	Treated ischaemic heart disease	Heart transplant
	Myocarditis	New ischaemic heart disease