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Medical disorders in pregnancyFree in the app

Rheumatic mitral stenosis

Common in Pakistan. Tachycardia and fluid kill.

Source: ESC 2018/2025
Pregnancy raises heart rate and volume, so a stable woman can go into pulmonary oedema, often in the third trimester or just after birth.

Antenatal

  1. Echo: valve area and pulmonary pressure. Valve area below 1.5 cm² is significant.
  2. Symptoms or pulmonary pressure above 50 mmHg: rest, beta-1 selective blocker (metoprolol or bisoprolol) to slow the heart.
  3. Diuretic (furosemide) at the lowest dose for congestion; avoid over-diuresis.
  4. Anticoagulate if AF, left atrial clot or previous embolism.
  5. Balloon valvotomy in pregnancy if NYHA III–IV despite treatment, ideally after 20 weeks.

Labour

  1. Vaginal birth for mild disease; consider CS for moderate or severe with symptoms.
  2. Early epidural; shorten the second stage with assisted birth.
  3. Strict fluid balance; restrict IV fluids.
  4. Third stage: slow oxytocin infusion, no bolus. No ergometrine.
  5. Watch closely for pulmonary oedema in the first hours after birth.
A summary for trained clinicians. Always check the full guideline, the patient in front of you and your hospital's protocol. Spotted an error? Tell us.