A pregnant woman with peripartum cardiomyopathy (PPCM) presents at 38 weeks gestation with an ejection fraction of 25% and pulmonary oedema. She is on furosemide and digoxin. Which drug is CONTRAINDICATED in her management during pregnancy?
- A Beta-blocker (carvedilol)
- B Low-molecular-weight heparin
- C ACE inhibitor (enalapril) ✓
- D Hydralazine with nitrates
Correct answer: C. ACE inhibitor (enalapril)
Explanation
ACE inhibitors are teratogenic in the 2nd and 3rd trimesters, causing fetal renal dysgenesis, oligohydramnios, skull ossification defects, and neonatal renal failure (fetopathy). They are absolutely contraindicated during pregnancy. In PPCM during pregnancy, afterload reduction is achieved with hydralazine + nitrates as the safe alternative. Beta-blockers (carvedilol) are used post-delivery. LMWH is indicated for thromboprophylaxis given the low EF and risk of LV thrombus. After delivery, standard heart failure therapy (ACE-I, beta-blocker, spironolactone) is instituted.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.