A pregnant woman with known rheumatic mitral stenosis at 20 weeks develops progressive dyspnoea. Echocardiography shows severe MS with mitral valve area 0.9 cm². Heart rate is 100 bpm and AF has developed. The most appropriate immediate management is:
- A Emergency mitral valve replacement surgery
- B IV beta-blocker for rate control followed by anticoagulation ✓
- C Percutaneous balloon mitral valvuloplasty (PBMV)
- D Digitalisation for rate control and diuretics
Correct answer: B. IV beta-blocker for rate control followed by anticoagulation
Explanation
In severe symptomatic mitral stenosis complicating pregnancy with new-onset AF, the immediate priorities are rate control (to prolong diastolic filling time) and anticoagulation (to prevent systemic thromboembolism). IV metoprolol or diltiazem achieves rapid rate control. Anticoagulation with LMWH is essential in pregnant AF. PBMV is considered if medical management fails and is the procedure of choice during pregnancy (avoiding cardiopulmonary bypass). Mitral valve replacement is avoided in pregnancy due to teratogenicity of prosthetic valve anticoagulation and bypass risks.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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