With the opening of the two-child policy and the imminent liberalization of the full two-child policy, many mothers, especially senior mothers, are excited to have a second child. Before having a second child I would like to ask you two questions: Are you financially ready? Are you physically ready? (1) Which women with cardiovascular disease should not be pregnant? (2) What should I do if I get pregnant? (3) Who can have a pregnancy despite having a combination of cardiovascular diseases? Especially in the case of a second child, I would say that in the spirit of responsibility for yourself and your first child, you must think it through and cherish it! First of all, from the special physiological changes of pregnancy: (1) the most significant cardiovascular aspects of pregnancy is the increase in blood volume, normal 20-32 weeks of pregnancy blood volume can exceed non-pregnancy by more than 50%. The increase in heart rate and cardiac output increases to an increase in cardiac output, along with a decrease in body vascular resistance and pulmonary vascular resistance, and a further increase in cardiac output during delivery, with a 34% increase in cardiac output in normal vaginal delivery and a 47% increase in cardiac index in cesarean delivery and spinal anesthesia. The risk period is from the 5th to 8th month of pregnancy to 48 hours after delivery. (2) Normal pregnancy leads to a hypercoagulable state of blood due to physiological, hormonal and blood composition changes, progesterone mediates venous dilatation and blood stasis, while the enlarged uterus compresses the common iliac vein, blood composition changes lead to an increase in circulating coagulation substances, decreased protein S, resistance to activated protein C, increased fibrin production and decreased fibrinolytic activity. When it comes to pregnancy combined with cardiovascular disease, my thoughts start to drift away, and the past scenes come to my eyes like a movie, and I can’t get rid of them for a long time. In the 10 years since I graduated from Zhejiang University and went to work in Jiangsu Provincial People’s Hospital, my job position has changed from emergency medicine to maternal and child cardiology, in which I have seen and rescued many pregnant women with high-risk cardiovascular disease, with many successes and failures. I have seen many pregnant women who were not advised to get pregnant by their doctors, and then had to terminate their pregnancies because they had obvious symptoms that they could not tolerate, and most tragically, neither the mother nor the baby was saved. Although working in the hospital for so many years, I am used to seeing life and death, but still can not accept the young in order to have a child, died young, that painful scene can not bear to see. The first is congenital heart disease ventricular septal defect, postpartum due to various factors, resulting in a sharp increase in pulmonary artery pressure, there is a significant right-to-left shunt, Eisenmenger syndrome, lost the opportunity to operate, and finally died of hypoxia, remember that the girl was only 18 years old; the second is Marfan’s syndrome, 3 months of pregnancy combined with aortic coarctation, and finally died of a full aortic tear, could not be rescued, later I learned The third one is SLE combined with severe pulmonary hypertension, the pregnant woman’s SLE has been under the control of rheumatologists, but both the doctors and the pregnant woman ignored the clinical importance of pulmonary hypertension. both ignored the clinical manifestations of pulmonary hypertension, because the manifestations of pulmonary hypertension, such as shortness of breath and edema, can often be found in normal pregnant women and are easily ignored. Therefore, this patient came to our hospital with obvious pulmonary hypertension, which resulted in sudden cardiac and respiratory arrest at the time of delivery, and most always could not be resuscitated (the mortality rate of patients with combined pulmonary hypertension in pregnancy is 30-56%); the fourth is a twin pregnancy complicated by perinatal cardiomyopathy, acute heart failure, unable to lie down, unable to continue the pregnancy, so we had to remove the fetus by caesarean section, only to remove the fetus, and the pregnant woman suffered respiratory and cardiac arrest. Perinatal cardiomyopathy is a specific cardiomyopathy that occurs specifically in late pregnancy and the postpartum period, with a high perinatal mortality rate; the fifth is hypertension in pregnancy combined with HELLP syndrome, thrombocytopenia, and death from cerebral hemorrhage. Of course, there are successful cases, such as the pregnant woman who was 5 months pregnant and had persistent atrial flutter for 3 months, resulting in tachycardia cardiomyopathy and decreased cardiac function, who was eventually successfully electrically resuscitated by us and eventually successfully delivered a baby boy. Most of the pregnant women with hyperemesis, pulmonary embolism, perinatal cardiomyopathy and arrhythmias were turned around and the mother and child were safe with the joint efforts of cardiology, obstetrics, anesthesiology and neonatology. However, the tangle and communication between doctors and family members, the sweat of doctors and the tears of family members are intertwined in the middle, and the significant cost, including spiritual and financial, is really a mixed feeling, which will be unforgettable for a lifetime for anyone who has experienced it. Based on these painful lessons, both the American and European Cardiovascular Societies prohibit pregnancy in the following cases: (1) pulmonary hypertension from any cause; (2) severe cardiac insufficiency (left ventricular ejection fraction less than 30%); (3) severe mitral and aortic stenosis; (4) Marfan’s syndrome with aortic dilatation ≥ 45 mm; (5) bilobed aorta with aortic dilatation ≥ 50 mm; (6) severe congenital aortic constriction. Therefore, if you have the above conditions, you must find a cardiovascular doctor to properly evaluate before preparing for pregnancy, and if once you find an early pregnancy, you must go to the hospital to terminate the pregnancy early, otherwise the consequences are unthinkable!