A 30-year-old woman with rheumatic heart disease consisting of mitral stenosis and mild aortic regurgitation is NYHA Class III before conception. She wishes to become pregnant. What is the most appropriate advice?

• A Pregnancy is well tolerated with close cardiology follow-up
• B Pregnancy is acceptable if anticoagulation is started prophylactically
• C Pregnancy is acceptable only if delivery is planned by elective caesarean section
• D Pregnancy should be avoided until cardiac status improves to NYHA Class I or II ✓

Explanation

NYHA Class III or IV cardiac status before pregnancy predicts major maternal morbidity and mortality, with decompensation typical in the second trimester, third trimester, and labour. Standard teaching holds that such patients should be advised against pregnancy until corrective surgery or medical optimisation achieves Class I or II status. Caesarean delivery does not remove the haemodynamic burden of pregnancy itself, and prophylactic anticoagulation offers no protection against cardiac decompensation in valvular disease.

Reference: Ian Donald's Practical Obstetric Problems, 8th ed.

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Written and medically reviewed by the StethoPrep medical team.