A 23-year-old South African primigravida woman presents to you in early pregnancy and mentions that she was diagnosed with rheumatic heart disease as a child before she immigrated to the United Sates. Further clinical examination and investigation reveals a diagnosis of mitral stenosis.
Electrocardiography (ECG) shows sinus rhythm. Echocardiography reveals good left ventricular function with no left atrial dilatation, and with an aortic valve area of 1.8 cm2. She is clinically well, and is classified as New York Heart Association Functional Classification II, with mild dyspnea on exercise and fatigue.
Which of the following statements regarding the management of this patient’s condition is correct?
- Early epidural anesthesia is important in labor to reduce maternal heart rate and blunt sympathetic responses to pain, and high doses may be necessary for symptom control.
- The risk of maternal mortality is as high as 3%. She warrants bimonthly echocardiography, because she has a high risk of cardiac failure that increases as the pregnancy progresses and can quickly cause pulmonary edema.
- Percutaneous mitral commissurotomy is a high-risk procedure in pregnancy and should be delayed until after delivery if possible, even if she develops pulmonary hypertension.
- The risk of thromboembolism is high, so she should be immediately started on anticoagulation therapy.
This question appears in Med-Challenger OBGYN Exam Review with CME
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