The Confidential Enquiry into Maternal Deaths (CEMACH) in the UK identified the leading direct and indirect causes of maternal mortality. Among cardiac causes, which condition has emerged as the leading indirect cause of maternal death in developed countries?

• A Rheumatic mitral stenosis with acute pulmonary edema
• B Acute myocardial infarction due to pregnancy-associated spontaneous coronary artery dissection (SCAD) ✓
• C Peripartum cardiomyopathy with acute heart failure
• D Aortic dissection in Marfan syndrome

Explanation

Spontaneous coronary artery dissection (SCAD) has emerged as the leading cause of pregnancy-associated myocardial infarction (PAMI), accounting for 40–43% of MI in pregnancy compared to atherothrombus in non-pregnant populations. SCAD causes intimal tear with intramural hematoma, narrowing or obstructing the coronary lumen. It most commonly affects the LAD and presents in the peripartum period. Peripartum cardiomyopathy is also important, but SCAD-related MI has overtaken classic atherosclerotic MI as the leading cardiac cause of maternal death in developed countries. Rheumatic heart disease remains important in developing countries.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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