A 24-year-old primigravida at 30 weeks gestation presents with exertional dyspnea and palpitations. Echocardiography reveals severe aortic regurgitation with left ventricular end-diastolic diameter 65 mm, ejection fraction 55%, and no symptoms at rest. According to the modified WHO classification, what is the risk category and recommended management?

• A mWHO Class I: minimal risk, no cardiology follow-up needed beyond routine obstetric care
• B mWHO Class II: small increase risk, cardiology follow-up each trimester
• C mWHO Class III: significantly increased risk, specialized cardiology follow-up each month, and consider early delivery ✓
• D mWHO Class IV: extremely high risk, pregnancy contraindicated and termination should be discussed

Explanation

Severe aortic regurgitation with left ventricular dilation (LVEDD greater than 65 mm) in a symptomatic patient places her in mWHO Class III, which carries significantly increased maternal cardiovascular risk and requires specialized cardiology follow-up with monthly or more frequent evaluation. Distractor A applies to uncomplicated mild lesions. Distractor B applies to uncomplicated moderate lesions or mild left ventricular dysfunction. Distractor D applies to conditions like severe pulmonary hypertension, severe systemic ventricular dysfunction, or Marfan syndrome with aortic root greater than 45 mm.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.