A pregnant woman with known mitral stenosis (MVA 1.2 cm²) is 28 weeks gestation. She develops progressive dyspnea and orthopnea with NYHA Class III symptoms. Heart rate is 115 bpm. Which management is MOST appropriate?
- A Immediate delivery by cesarean section
- B Percutaneous balloon mitral valvotomy (PBMV)
- C Rate control with beta-blocker and diuresis ✓
- D Open mitral valve replacement under cardiopulmonary bypass
Explanation
For symptomatic mitral stenosis in pregnancy, initial management is medical: heart rate control (beta-blockers reduce diastolic filling time demands), diuretics for pulmonary congestion, and restriction of activity. If medical management fails in significant MS (MVA <1.5 cm²), PBMV is the intervention of choice during pregnancy as it avoids the need for CPB and has good maternal-fetal outcomes when performed after 20 weeks by experienced operators. Open valve surgery under CPB carries a high fetal mortality (~20–30%). Delivery is not indicated at 28 weeks unless maternal condition is immediately life-threatening and unresponsive to medical therapy.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.