A 25-year-old G1P0 with Marfan syndrome has an aortic root diameter of 3.2 cm on serial echocardiography, stable across two scans. She is on labetalol. Which statement about her intrapartum management is CORRECT?
- A Caesarean delivery is mandatory regardless of aortic root size
- B Beta blockers must be stopped in the third trimester
- C Vaginal delivery is reasonable when the aortic root is below 4.0 cm and stable ✓
- D Epidural analgesia is contraindicated in Marfan syndrome
Correct answer: C. Vaginal delivery is reasonable when the aortic root is below 4.0 cm and stable
Explanation
When the aortic root measures less than 4.0 cm and remains stable, vaginal delivery with epidural analgesia to blunt the Valsalva response is acceptable. Caesarean delivery is recommended for a root of 4.0 cm or greater, rapid progression, or dissection, since expulsive effort can precipitate dissection. Beta blockade is continued throughout pregnancy because it slows the rate of aortic dilation, and epidural analgesia is encouraged rather than contraindicated in these patients.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.