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Research project

ROPAC Pregnancy and Cardiac Disease

Status: Ongoing project. Start date: 2007 End date: 2024.

Cardiac disease is the leading cause for maternal mortality in developed countries. A better understanding of this group is crucial to improve pregnancy care.

What we do

About our project


Major advances in the therapy and surgery of congenital heart disease have been made in the last decade, with dramatically improved survival as a result. These women are now reaching the fertile age and decide to become pregnant. Pregnancy, however, comes with big hemodynamic changes and can be a burden for the heart even in healthy women. Maternal heart disease accounts for up to 15% of maternal mortality. Our current knowledge on the impact of pregnancy on cardiac disease is limited, as are protocols for how to best handle these pregnancies.

Aim of the study

To provide women and their caregivers with evidence based guidance on clinical management decisions, a large worldwide database was established in 2007 – the Registry of Pregnancy and Cardiac Disease (ROPAC). International guidelines on this subject have since then been based on the outcomes of this registry. Its current edition, the ROPAC III, will focus on patients with aortic disease and prosthetic heart valves.

Our research focus


This prospective registry will analyze the course and outcomes of pregnancies in women with two areas of focus:

  • Aortic pathology, which is the leading cause of cardiac mortality during pregnancy.
  • Prosthetic heart valves, where optimization of anticoagulation regime is necessary since major problems stem from valve thrombosis and bleeding complications.

Maternal and fetal mortality and morbidity will be analyzed. The changes in maternal cardiac function as consequence of pregnancy will be assessed. The management decisions and interventions, such as caesarean section, will be evaluated for impact on results.



The knowledge on the exact hemodynamic changes that occur during the entire process of labor is outdated. Research on this subject has traditionally been hindered by the invasive nature of hemodynamic monitoring. Non-invasive techniques as impedance cardiography have recently been fine-tuned, providing a promising alternative.

With this method, the Physioflow, it is now possible to monitor cardiac output delivery – and evaluate the effects of interventions such as epidural analgesia or ventouse delivery. Differences in changes in cardiac function between healthy women and women with cardiac disease will be assessed, to improve labor plans for these women in the future.

Funds & Grants

This project is funded by the EURObservational Research Program (EORP) of the European Society of Cardiology (ESC) and the Erasmus Thorax Foundation.


Collaborations within Erasmus MC

  • The department of Cardiology collaborates with the department of Obstetrics and Gynecology for this project.

Collaborations outside of Erasmus MC


J. Roos-Hesselink, L. Baris, M. Johnson et al. Pregnancy outcomes in women with cardiovascular disease: evolving trends over 10 years in the ESC Registry of Pregnancy And Cardiac disease (ROPAC). Eur Heart J. 2019 Mar 25.

I. van Hagen, J. Roos-Hesselink, T. Ruys et al. Pregnancy in Women With a Mechanical Heart Valve: Data of the European Society of Cardiology Registry of Pregnancy and Cardiac Disease (ROPAC). Circulation. 2015 Jul 14;132(2);132-42.

I. van Hagen, J. Roos-Hesselink. Aorta pathology and Pregnancy. Best Pract Res Clin Obstet Gynaecol. 2014 May;28(4):537-50.

Our team