According to the modified WHO classification (mWHO) of cardiovascular risk in pregnancy, Eisenmenger syndrome is classified as:

• A mWHO Class II (small increased risk, close monitoring required)
• B mWHO Class III (significantly increased risk, expert care needed)
• C mWHO Class II-III (moderate risk, can proceed with monitoring)
• D mWHO Class IV (extremely high risk; pregnancy contraindicated) ✓

Explanation

The modified WHO (mWHO) classification places Eisenmenger syndrome (pulmonary arterial hypertension with reversed shunt) in Class IV — conditions where pregnancy is associated with extremely high risk of maternal mortality or severe morbidity, and where pregnancy is CONTRAINDICATED. Maternal mortality in Eisenmenger syndrome is 30–50%. Other mWHO IV conditions include severe systemic ventricular dysfunction (EF <30%), severe symptomatic mitral/aortic stenosis, and Marfan syndrome with aortic root >45 mm. Women with these conditions should be strongly counselled against pregnancy.

Reference: Williams Obstetrics, 26th ed.

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Written and medically reviewed by the StethoPrep medical team.