A 31-year-old G2P1 with severe rheumatic mitral stenosis is admitted in early labour at term. She is haemodynamically stable. Which intrapartum plan is MOST appropriate?

• A Encourage prolonged bearing down in the second stage to achieve spontaneous delivery
• B Withhold epidural analgesia because it causes dangerous vasodilation
• C Perform elective caesarean section at the onset of labour in all cases
• D Plan assisted vaginal delivery with effective regional analgesia to shorten the second stage ✓

Explanation

Valsalva manoeuvre in the second stage causes cyclical swings in venous return and afterload, which the stenotic heart tolerates poorly, so the second stage is shortened with forceps or vacuum under regional analgesia. Epidural analgesia is desirable, not contraindicated, provided hypotension is avoided with careful titration and preload. Caesarean section adds surgical bleeding, fluid shifts and infection risk, and is reserved for obstetric indications or refractory cardiac decompensation.

Reference: DC Dutta's Textbook of Obstetrics, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.