Routine echocardiography for all pregnant women to rule out heart disease ? What does the latest ESC 2025 guidelines say ?
September 3, 2025 by dr s venkatesan
This post was written recently in this site , which had mixed reactions.
Now, in 2025 ESC guidelines are more assertive . Just because a women is pregnant , she doesn’t become eligible for an echocardiogram. May be, the new guidelines suggest we can do it liberally , but definitely not as routine .Please note ,it is still backed up by that mystery 1-C evidence base.
The three key words are
In any pregnant women
1.Unexplained cardiac symptoms
2 New cardio vascular sign
3. New cardio vascular symptom
All preganant women with H/O pre existing heart disease ( treated or untreated)
I think, they could have included this in the same table. Any pregnant women with a known history of past heart disease, with or without symptoms, must undergo a detailed evaluation of the current hemodynamic status.
Final message
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 is 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 guidlines should instill confidence to ignore physiological symptoms.
Counterpoint( Extract taken in from real time , after a one to one debate )
I am a leading obstetrician, practicing In Chennai. I am Sorry to say this. It is long time we lost confidence in clinical skills. In this technological era, we are unable to rely a physician or even a cardiologist. Echo is an easy way out. In fact, let it be a secret one of my colleague cardiologist said , many among themselves are not confident enough to tell , a heart is normal without echo.
We are aware of the implications of defying these guidelines. 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 relive our anxiety at the cost of patients. We will always reassure them , explaining these are minor issues. Again make a pardon.
Reference
https://academic.oup.com/eurheartj/article-lookup/doi/10.1093/eurheartj/ehaf193
