In a pregnant woman with structural heart disease, at which point is the haemodynamic load greatest and decompensation most likely?

• A First trimester, at the time of peak heart rate rise
• B Immediately after delivery, in the first 24 to 72 hours ✓
• C Second trimester, at maximum blood volume expansion
• D During active second stage of labour

Explanation

Delivery relieves caval compression and the contracting uterus returns roughly 300 to 500 mL of blood to the circulation, producing sudden preload surges in the first minutes to days postpartum. Cardiac output peaks then, exceeding even intrapartum values, so pulmonary oedema classically occurs immediately after birth. Labour itself is demanding, but the autotransfusion of the puerperium creates the greatest load.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.