Question

How will you manage a 25-year-old G2P1 with 30 weeks pregnancy with mitral valve replacement 2 years back?

Hint:

When managing pregnancies in women with a history of mitral valve replacement, it is essential to carefully balance anticoagulation therapy to prevent both maternal and fetal complications.

Answer 1

Step 1: Assessing the Situation.
A 25-year-old woman with a history of mitral valve replacement (MVR) is now pregnant at 30 weeks. Pregnancy increases the workload on the heart, so close monitoring of maternal and fetal health is essential.

Step 2: Anticoagulation Management.
Patients with mechanical valve replacements typically require anticoagulation to prevent thromboembolic events. However, during pregnancy, anticoagulants such as warfarin are contraindicated due to teratogenic risks. Low molecular weight heparin (LMWH) is preferred to manage anticoagulation. Close monitoring of the anticoagulation therapy is crucial.

Step 3: Cardiac Monitoring.
The woman should be closely monitored for signs of heart failure or complications, such as arrhythmias or thromboembolic events. Echocardiography can be used to assess valve function and detect any complications related to the mitral valve replacement.

Step 4: Fetal Monitoring.
Fetal well-being should be closely monitored through regular ultrasounds, non-stress tests (NST), and biophysical profiles to ensure proper fetal growth and development.

Step 5: Conclusion.
This case requires a multidisciplinary approach involving obstetricians, cardiologists, and anesthesiologists to ensure optimal maternal and fetal outcomes. Regular monitoring, appropriate anticoagulation management, and prevention of complications are key to successful pregnancy management in such cases.