Management of Heart Disease in Pregnancy Flashcards
What is the preferred mode of delivery for most pregnant women with heart disease?
A. Vaginal delivery
B. Cesarean section
C. Assisted vaginal delivery only
D. Induction is contraindicated
A. Vaginal delivery
Rationale: Vaginal delivery is less invasive and avoids the sudden hemodynamic shifts associated with cesarean section. It is generally safer in stable heart disease cases (Buzzwords: preferred mode, stable hemodynamics, less invasive).
Which of the following is an indication for cesarean delivery in a pregnant woman with heart disease?
A. NYHA Class II status
B. Dilated aortic root (>4 cm) or aneurysm
C. Pulmonary edema during labor
D. Persistent tachycardia during induction
B. Dilated aortic root (>4 cm) or aneurysm
Rationale: Cesarean delivery is indicated in conditions where the stress of labor could precipitate complications, such as aortic dissection or rupture in dilated aortic roots (Buzzwords: aortic dilation, rupture risk, cesarean indication).
Which analgesia method is preferred during labor in a woman with significant hemodynamic compromise?
A. Subarachnoid block
B. General anesthesia
C. Epidural analgesia
D. Narcotic regional analgesia
D. Narcotic regional analgesia
Rationale: Narcotic regional analgesia minimizes hemodynamic fluctuations and avoids the profound hypotension risk seen with subarachnoid block in compromised patients (Buzzwords: stable hemodynamics, avoid hypotension, narcotic regional).
Intrapartum management of pulmonary edema during labor involves:
A. Fluid resuscitation and increasing preload
B. Diuretics and rate control with beta-blockers
C. Epidural analgesia to reduce cardiac output
D. Immediate cesarean section to relieve symptoms
B. Diuretics and rate control with beta-blockers
Rationale: Diuretics reduce fluid overload, while beta-blockers manage tachycardia, improving cardiac output efficiency and preventing further decompensation (Buzzwords: pulmonary congestion, fluid overload, rate control).
Which position is recommended during labor for a pregnant woman with heart disease to optimize hemodynamics?
A. Supine position with legs elevated
B. Semi-recumbent position with lateral tilt
C. Prone position with lateral monitoring
D. Upright position for better oxygenation
B. Semi-recumbent position with lateral tilt
Rationale: This position improves venous return, reduces preload, and minimizes aortocaval compression, optimizing cardiac output (Buzzwords: optimize venous return, reduce compression, lateral tilt).
Why should subarachnoid block be avoided in patients with severe pulmonary hypertension during labor?
A. It causes increased cardiac output fluctuations
B. It increases the risk of fluid overload
C. It causes significant hypotension
D. It exacerbates tachycardia
C. It causes significant hypotension
Rationale: Pulmonary hypertension patients cannot tolerate the sudden drop in systemic vascular resistance caused by subarachnoid block, which exacerbates hypotension and decompensation (Buzzwords: pulmonary hypertension, avoid hypotension, vascular resistance).
Postpartum heart failure is most commonly triggered by:
A. Dehydration from blood loss
B. Fluid mobilization and increased preload
C. Persistent tachycardia post-delivery
D. Epidural analgesia use during labor
B. Fluid mobilization and increased preload
Rationale: Postpartum fluid shifts increase preload, which can overwhelm a compromised heart, leading to pulmonary edema or decompensation (Buzzwords: fluid mobilization, increased preload, postpartum decompensation).
What is the key management strategy for postpartum heart failure in a woman with severe mitral stenosis?
A. Increase fluid intake to maintain blood pressure
B. Use diuretics to manage pulmonary congestion
C. Immediate cesarean section
D. Administer inotropes to strengthen cardiac output
B. Use diuretics to manage pulmonary congestion
Rationale: Diuretics reduce pulmonary congestion and left atrial pressures, alleviating symptoms in mitral stenosis patients (Buzzwords: pulmonary congestion, left atrial pressure, diuretics).
Which lifestyle modification is crucial for pregnant women with heart disease to prevent complications?
A. Avoid routine exercise
B. Avoid smoking and illicit drug use
C. Restrict all fluid intake
D. Avoid vaccinations during pregnancy
B. Avoid smoking and illicit drug use
Rationale: Smoking and drugs like cocaine increase cardiovascular strain, elevating risks of arrhythmias, thrombosis, and myocardial infarction (Buzzwords: avoid smoking, arrhythmias, myocardial strain).
Why is frequent monitoring of vital signs, particularly pulse >100 bpm, critical during labor in women with heart disease?
A. To assess for infection
B. To monitor for tachycardia-related decompensation
C. To confirm labor progress
D. To assess for fetal distress
B. To monitor for tachycardia-related decompensation
Rationale: Persistent tachycardia increases myocardial oxygen demand and reduces diastolic filling time, potentially leading to decompensation (Buzzwords: tachycardia, decompensation, vital sign monitoring).
What vaccination is recommended for pregnant women with valvular heart disease?
A. Hepatitis B vaccine
B. Influenza and pneumococcal vaccines
C. MMR vaccine
D. Tetanus toxoid
B. Influenza and pneumococcal vaccines
Rationale: Respiratory infections can exacerbate heart disease and increase risk of endocarditis, making these vaccinations critical (Buzzwords: prevent endocarditis, infection prevention, influenza vaccine).
Why is induction of labor preferred in pregnant women with heart disease?
A. To avoid fetal distress during spontaneous labor
B. To reduce the risks associated with emergency delivery
C. To prevent maternal infection during prolonged labor
D. To allow for epidural analgesia
B. To reduce the risks associated with emergency delivery
Rationale: Induction allows planned management, avoids the hemodynamic stress of emergency labor, and provides controlled analgesia (Buzzwords: planned management, avoid emergency, controlled delivery).
When should tubal sterilization be performed in a woman with severe heart disease?
A. Immediately after delivery
B. After the patient is hemodynamically stable
C. During labor to avoid postpartum complications
D. Before delivery to reduce cardiac stress
B. After the patient is hemodynamically stable
Rationale: Tubal sterilization is delayed until the patient is stable to avoid exacerbating hemodynamic compromise (Buzzwords: stabilize first, avoid complications, delayed sterilization).
Which intrapartum complication is most concerning for a pregnant woman with severe aortic stenosis?
A. Hypotension due to epidural analgesia
B. Fluid overload causing pulmonary edema
C. Tachycardia causing arrhythmias
D. Increased cardiac output fluctuations during vaginal delivery
B. Fluid overload causing pulmonary edema
Rationale: Severe aortic stenosis limits forward flow, making the heart vulnerable to fluid overload and resultant pulmonary congestion (Buzzwords: aortic stenosis, pulmonary edema, fluid overload).
What is the role of a multidisciplinary team in managing heart disease during pregnancy?
A. To avoid the need for cesarean delivery
B. To optimize care and minimize risks for both mother and fetus
C. To ensure that routine antenatal care is sufficient
D. To monitor only fetal well-being
B. To optimize care and minimize risks for both mother and fetus
Rationale: A multidisciplinary team ensures comprehensive care addressing the complex interplay of cardiac, obstetric, and neonatal concerns (Buzzwords: comprehensive care, minimize risks, optimize outcomes).
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Which congenital heart defect is commonly repaired during childhood and has good pregnancy outcomes?
- A. Tetralogy of Fallot
- B. Bicuspid aortic valve
- C. Eisenmenger syndrome
- D. Aortic root aneurysm
B. Bicuspid aortic valve
Rationale: Bicuspid aortic valve is typically repaired in childhood and, if well-managed, allows for favorable pregnancy outcomes. It’s less likely to cause complications compared to conditions like Tetralogy of Fallot or Eisenmenger syndrome (Buzzwords: childhood repair, good pregnancy outcomes).
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Which type of heart valve replacement requires lifelong anticoagulation during pregnancy?
- A. Bioprosthetic valve
- B. Mechanical valve
- C. Transcatheter valve
- D. Native valve with mild regurgitation
B. Mechanical valve
Rationale: Mechanical valves require lifelong anticoagulation to prevent thromboembolism. Pregnancy poses additional risks due to hypercoagulability and anticoagulant-associated complications (Buzzwords: lifelong anticoagulation, hypercoagulability).
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Which complication is associated with mechanical heart valves during pregnancy?
- A. Valvular dysfunction without anticoagulation
- B. Thromboembolism and hemorrhage
- C. Spontaneous resolution of thrombus
- D. Low fetal loss rates
B. Thromboembolism and hemorrhage
Rationale: Mechanical valves carry risks of thromboembolism and hemorrhage during pregnancy, compounded by anticoagulation therapy (Buzzwords: thromboembolism, hemorrhage, anticoagulation risk).
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Why are bioprosthetic valves considered safer than mechanical valves during pregnancy?
- A. Require less frequent monitoring
- B. Do not require anticoagulation
- C. Do not have a risk of valvular dysfunction
- D. Longer durability than mechanical valves
B. Do not require anticoagulation
Rationale: Bioprosthetic valves do not necessitate anticoagulation, reducing maternal and fetal risks associated with warfarin or heparin use. However, their shorter lifespan remains a limitation (Buzzwords: no anticoagulation, safer pregnancy outcomes).
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What is the primary risk of warfarin use during pregnancy?
- A. Increased maternal thromboembolism
- B. Fetal anomalies and miscarriage (dose-dependent teratogenicity)
- C. Excessive anticoagulation in the third trimester
- D. Ineffectiveness at preventing maternal thromboembolism
B. Fetal anomalies and miscarriage (dose-dependent teratogenicity)
Rationale: Warfarin is teratogenic, particularly at doses >5 mg/day, leading to fetal anomalies, miscarriage, and fetal hemorrhage (Buzzwords: warfarin embryopathy, teratogenicity, dose-dependent risk).
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What is the preferred anticoagulant during pregnancy for women with mechanical valves?
- A. Low-dose warfarin throughout pregnancy
- B. Low-molecular-weight heparin (LMWH) with adjusted dosing
- C. Aspirin monotherapy
- D. Unfractionated heparin (UFH) without dose adjustment
B. Low-molecular-weight heparin (LMWH) with adjusted dosing
Rationale: LMWH is the preferred anticoagulant due to its safety profile for the fetus, and dosing is adjusted to maintain therapeutic anti-Xa levels (Buzzwords: fetal safety, adjusted dosing, anti-Xa monitoring).
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What is the recommended therapeutic range for anti-Xa levels during LMWH therapy in pregnancy?
- A. 0.25–0.5 IU/mL
- B. 0.35–0.7 IU/mL
- C. 0.8–1.2 IU/mL
- D. 1.0–2.0 IU/mL
B. 0.35–0.7 IU/mL
Rationale: Anti-Xa levels ensure adequate anticoagulation, balancing the prevention of thromboembolism and minimizing bleeding risks (Buzzwords: therapeutic range, anti-Xa monitoring).
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Which anticoagulation strategy is recommended postpartum for women with mechanical valves?
- A. Continue LMWH for 6 weeks
- B. Resume warfarin with bridging therapy
- C. Transition to aspirin therapy
- D. Discontinue anticoagulation entirely
B. Resume warfarin with bridging therapy
Rationale: Warfarin is resumed postpartum due to its superior efficacy in preventing valve thrombosis, with LMWH used for bridging until warfarin reaches therapeutic levels (Buzzwords: postpartum anticoagulation, bridging therapy).
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What is the primary fetal risk associated with anticoagulation therapy using warfarin during pregnancy?
- A. Intrauterine growth restriction
- B. Fetal hemorrhage and anomalies
- C. Premature closure of the ductus arteriosus
- D. Oligohydramnios
B. Fetal hemorrhage and anomalies
Rationale: Warfarin crosses the placenta, causing fetal hemorrhage and structural anomalies, especially during the first trimester (Buzzwords: placental transfer, fetal hemorrhage, anomalies).
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What is the maternal risk of low-dose unfractionated heparin (UFH) therapy during pregnancy?
- A. Adequate prevention of thromboembolism
- B. High risk of maternal mortality and inadequate anticoagulation
- C. Reduced risk of bleeding during delivery
- D. Superior to LMWH in efficacy
B. High risk of maternal mortality and inadequate anticoagulation
Rationale: Low-dose UFH is insufficient for mechanical valve thrombosis prevention, leading to high maternal mortality and thrombotic risks (Buzzwords: inadequate anticoagulation, high maternal risk).
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Cardiac surgery during pregnancy is most commonly indicated for which condition?
- A. Severe valvular dysfunction or life-threatening complications
- B. Bioprosthetic valve dysfunction without symptoms
- C. Stable mechanical valve patient
- D. Mild mitral regurgitation
A. Severe valvular dysfunction or life-threatening complications
Rationale: Life-threatening conditions like severe valve stenosis or regurgitation necessitate surgery even during pregnancy (Buzzwords: life-threatening, severe valvular dysfunction, urgent surgery).
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What is the preferred approach to manage a pregnant woman post-heart transplantation?
- A. Cesarean delivery for all cases
- B. Multidisciplinary care and monitoring for graft rejection
- C. Avoid all immunosuppressive therapy during pregnancy
- D. Delay pregnancy until 6 months post-transplant
B. Multidisciplinary care and monitoring for graft rejection
Rationale: Post-transplant patients require specialized monitoring for graft rejection, infections, and complications like hypertension (Buzzwords: graft rejection, multidisciplinary care, transplant outcomes).
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What is the most common complication of cardiopulmonary bypass during pregnancy?
- A. Hemorrhage only affecting the mother
- B. High fetal morbidity, including preterm birth and fetal loss
- C. Complete resolution of maternal cardiac issues
- D. Permanent cessation of fetal circulation
B. High fetal morbidity, including preterm birth and fetal loss
Rationale: Cardiopulmonary bypass during pregnancy is associated with significant risks of preterm labor and fetal loss due to placental hypoperfusion (Buzzwords: fetal morbidity, preterm birth, placental hypoperfusion).
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Which parameter is critical to maintain during cardiopulmonary bypass in pregnancy?
- A. Hematocrit >28% and pump flow >2.5 L/min/m²
- B. Fetal heart rate >120 bpm
- C. Maternal blood pressure <100/60 mmHg
- D. Minimal hematocrit of 20%
A. Hematocrit >28% and pump flow >2.5 L/min/m²
Rationale: Maintaining adequate hematocrit and pump flow ensures sufficient oxygen delivery to the fetus and prevents placental hypoxia (Buzzwords: hematocrit >28%, pump flow, placental oxygenation).
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What is the most critical counseling point for women with mechanical heart valves considering pregnancy?
- A. Stop anticoagulation therapy in the first trimester
- B. Discuss fetal and maternal risks, including anticoagulation complications
- C. Avoid low-dose warfarin during pregnancy
- D. Transition to aspirin monotherapy postpartum
B. Discuss fetal and maternal risks, including anticoagulation complications
Rationale: Pre-pregnancy counseling must address the dual risks of maternal thromboembolism and fetal complications from anticoagulation (Buzzwords: maternal thromboembolism, fetal risks, counseling).
