A 28-year-old primigravida with rheumatic mitral stenosis (valve area 1.0 cm²) develops exertional dyspnoea at 22 weeks. She is in NYHA Class III. The most appropriate management at this stage, before resorting to delivery, is:

• A Immediate caesarean section at 22 weeks
• B Open mitral commissurotomy
• C Mitral valve replacement with mechanical prosthesis
• D Percutaneous balloon mitral valvuloplasty (PBMV) ✓

Explanation

Percutaneous balloon mitral valvuloplasty (PBMV) is the procedure of choice during pregnancy for severe symptomatic mitral stenosis (valve area < 1.5 cm², NYHA III/IV) when medical therapy fails; it can be safely performed after 20 weeks under echocardiographic guidance with minimal radiation using shields. Open surgery and mechanical valve replacement carry high maternal and fetal mortality and are reserved for cases where PBMV is not feasible. Delivery at 22 weeks is not viable.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.