A 26-year-old with Eisenmenger syndrome (VSD with reversed shunt) at 8 weeks gestation presents for counselling. What is the most critical piece of information regarding her prognosis?

• A With modern intensive care, maternal mortality is less than 5%
• B Eisenmenger syndrome is not a contraindication to pregnancy if managed by a specialist
• C Sildenafil use during pregnancy normalises pulmonary pressure and makes continuation safe
• D Maternal mortality remains 30–50% even with modern management; termination should be discussed ✓

Explanation

Eisenmenger syndrome carries a maternal mortality of 30–50% even with optimal management, principally from paradoxical embolism, arrhythmia, and pulmonary hypertensive crises during labour and the puerperium. Termination of pregnancy must be offered and discussed. Pulmonary vasodilators including sildenafil do not normalise pressure sufficiently to make pregnancy safe.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.