A woman with rheumatic mitral stenosis (valve area 0.9 cm²) and WHO Class III cardiac risk becomes pregnant. What is the PREFERRED mode of delivery management?

• A Elective cesarean section at 37 weeks
• B Induction of labour at 38 weeks with oxytocin
• C Balloon mitral valvuloplasty followed by vaginal delivery
• D Vaginal delivery with epidural analgesia and passive second stage (assisted delivery) ✓

Explanation

In women with significant mitral stenosis (MS) but compensated cardiac function, vaginal delivery with epidural analgesia is preferred over cesarean section because it avoids the hemodynamic stress of major surgery, blood loss, and general anesthesia. Passive second stage (avoiding Valsalva) with assisted delivery (forceps/ventouse) is recommended to reduce hemodynamic burden. Cesarean is reserved for obstetric indications or those in NYHA Class IV/decompensated disease.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.