A 30-year-old primigravida at 38 weeks gestation with severe mitral stenosis (valve area 0.8 cm², NYHA class II) presents in early labour. Which analgesic technique is MOST appropriate?

• A Intravenous morphine patient-controlled analgesia
• B Single-shot spinal anaesthesia with hyperbaric bupivacaine
• C Slowly titrated epidural anaesthesia with low-dose local anaesthetic ✓
• D Inhalational nitrous oxide 50% with oxygen

Explanation

In labouring patients with severe mitral stenosis, a slowly titrated epidural is preferred because it provides effective pain relief while allowing gradual onset of sympathetic blockade, avoiding sudden drops in preload or afterload. Single-shot spinal can cause rapid sympathetic blockade and catastrophic hypotension. Nitrous oxide provides inadequate analgesia for labour.

Reference: Chestnut's Obstetric Anaesthesia, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.