look with CHD. - thrombolyser

[ArchivalUser]

A 25-year-old female comes to your office because she thinks that she might be pregnant. She has been a patient of yours for the past year. When she first came to your office last year, she was complaining of shortness of breath that occurs œeven during the usual daily activities. In addition, her fingers would turn blue when she performed moderate activities. At that time, the physical findings and diagnostic work-up confirmed that she was suffering from ventricular septal defect with reversal of the shunt. She had developed severe pulmonary hypertension which had caused the shunt reversal and symptoms of poor-exercise tolerance. Ever since, you have been managing her conservatively with the help of a cardiologist. She currently insists that she might be pregnant because she had unprotected sexual intercourse approximately two months ago, and she has not had her menses since that episode. Her urine sample is positive for beta-HCG. Which of the following is the most appropriate next step in the management of this patient?
A. Continue conservative management and start treatment when she becomes symptomatic.
B. Recommend corrective surgery in the third trimester of pregnancy.
C. Monitor her closely during her pregnancy and advise caesarian section at 34 to 36 weeks of gestation.
D. Recommend an elective termination of pregnancy.

[ArchivalUser]

A?

[ArchivalUser]

from some journal

eisenmenger



so i think cc---unsure


Pregnancy ” Pregnancy carries a 30 to 50 percent risk of maternal mortality, with death usually occurring at delivery or within one week postpartum [13,14,15]. Most deaths are due to thromboembolism, hypovolemia (which increases the right-to-left shunt), or preeclampsia [13]. There is also appreciable fetal morbidity and mortality in this setting. Premature delivery occurs in at least 50 percent of cases, as only 15 to 25 percent of pregnancies progress to term [13,14,15]. Spontaneous abortion is common and there is appreciable mortality associated with prematurity.

For these reasons, pregnancy is contraindicated in patients with Eisenmenger syndrome and ,if pregnancy occurs, termination is suggested. However, for the patient who continues with pregnancy hospitalization at 20 weeks is advisable and vaginal delivery recommended.

Routine anticoagulation in pregnancy is controversial; it has been suggested that subcutaneous heparin be initiated at 20 weeks and discontinued immediately before planned delivery [3,14]. Anticoagulation with heparin and then warfarin should be initiated within two days after delivery.

[ArchivalUser]

ccc

[ArchivalUser]

A is d ans.

[ArchivalUser]

D

[ArchivalUser]

mortality is pretty high with eisenmenger physiology.
D?

[ArchivalUser]

bulls eye aaz.
b/c of high mortality D is right answer