07-04-2009, 06:31 PM
40. A 27-year-old nulligravid woman comes to the physician for preconceptional counseling. She has a mechanical mitral heart valve and chronic rheumatoid arthritis. Her cardiac status isNew York Heart Association Class II. She feels well. Current daily medications include warfarin, prednisone, and acetaminophen with codeine. Examination shows no abnormalities except for audible clicking from the heart valve. Which of the following is the most appropriate advice for this patient?
A) Chemical dependency counseling before pregnancy
B) Discontinuation of anticoagulant therapy during pregnancy
C) Discontinuation of prednisone during pregnancy
D) Switching from warfarin to heparin before pregnancy
E) No change in treatment before or during pregnancy
A) Chemical dependency counseling before pregnancy
B) Discontinuation of anticoagulant therapy during pregnancy
C) Discontinuation of prednisone during pregnancy
D) Switching from warfarin to heparin before pregnancy
E) No change in treatment before or during pregnancy