A pregnant woman with rheumatic heart disease has mitral stenosis with a valve area of 1.2 cm² and NYHA Class II symptoms. She is at 30 weeks. The haemodynamically preferred mode of delivery is:

• A Elective caesarean section at 36 weeks
• B Emergency caesarean under general anaesthesia
• C Spontaneous vaginal delivery without epidural
• D Vaginal delivery with epidural analgesia and shortened second stage ✓

Explanation

Vaginal delivery with carefully managed epidural analgesia is preferred in NYHA Class I–II mitral stenosis because caesarean section carries higher blood loss risk and major haemodynamic shifts. Epidural reduces cardiac afterload and pain-driven tachycardia, which is particularly dangerous in mitral stenosis (tight valves tolerate tachycardia poorly). The second stage is shortened with instrumental delivery to avoid prolonged bearing-down efforts. CS is reserved for obstetric indications or NYHA Class III–IV.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.