1. Pulmonary embolism (PE):  For suspected PE, if the suspicion is low, and d-dimer is less then 500 ng/mL, PE can generally be excluded. In general, the risks of radiation (from V/Q scanning and CTPA) and iodinated contrast are considered low. Risk scores include the YEARS algorithm for pregnancy. DOACs are not recommended in pregnancy. Use low molecular weight heparin instead.

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2. Chest pain: think Spontaneous coronary artery dissection (SCAD). In pregnancy and post-partum, exclude PE, acute coronary syndrome and acute aortic syndrome. Pregnancy-associated MI is most often spontaneous coronary artery dissection rather than plaque rupture. Most SCAD heals spontaneously; conservative management is preferred. Wiring or stenting can propagate the dissection.

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3. Cardiac arrest: start preparing to deliver immediately. Preparation for resuscitative delivery (previously known as perimortem C-section) — begins the moment arrest is recognized, with the goal of completing delivery by five minutes. Use continuous manual left uterine displacement from 20 weeks and place IV access above the diaphragm. Do not withhold drugs due to  teratogenicity concerns. Consider amniotic fluid embolism.

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4. Severe hypertension: Consider IV treatment for severe hypertension; systolic ≥160 and/or diastolic pressure ≥110 mmHg. For acute therapy, consider intravenous labetalol, nicardipine, or hydralazine. Oral therapy options also includes nifedipine. Reduce mean arterial pressure by no more than 25 percent over two hours to achieve initial target blood pressures in the range approximately 140 mmHg/90 mmHg.

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5. Think peripartum cardiomyopathy — for six months. Consider it in any new heart failure in late pregnancy or post-partum. Keep this diagnosis in mind for six months post-partum because of delayed decompensation and arrhythmic events.