A 26-year-old woman with rheumatic heart disease (mitral stenosis, mitral valve area 1.2 cm²) presents at 28 weeks gestation with dyspnoea on mild exertion, palpitations, and bilateral basal rales. She is in NYHA Class III. The safest drug for controlling her ventricular rate (atrial fibrillation with fast ventricular response) in pregnancy is:
- A Amiodarone
- B Adenosine IV
- C Digoxin ✓
- D Diltiazem
Correct answer: C. Digoxin
Explanation
Digoxin is the safest drug for rate control of atrial fibrillation in pregnancy with mitral stenosis; it does not adversely affect uterine blood flow and has an established safety profile in pregnancy. Amiodarone is associated with fetal hypothyroidism, growth restriction, and neonatal bradycardia (category D). Beta-blockers (e.g., metoprolol) are also acceptable. Diltiazem is category C. Adenosine is used for SVT, not rate control in AF. Digoxin remains the drug of choice in this scenario.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.