Mitral stenosis

Presented by Dr Sidra
 Introduction:
• Mitral stenosis is the most common rheumatic heart disease
in pregnancy
• Mitral stenosis complicating pregnancy still remain a
frequent cause of maternal death
• An asymptomatic patient may deterioate in pregnancy
• Stenosis can recur or worsen after valvuloplasty or
valvulotomy
• missed During antenatal examination due to low pitch
murmur
 Defination:
Mitral stenosis is a form
of valuvar heart disease
characterized by
narrowing of mitral
valve orfice .It impair
left ventricle filling
resulting decrease
stroke volume and
decrease cardiac output
Classification
Symptoms:
• Dysnea
• Orthopenea
• Fatiguibility
• Palpitation
• Chest pain
• Cough
• Right hypochondrail pain
• Reccurent bronchitis
• Hemoptysis
Maternal outcome:
• Most commonest complication is pulmonary oedema
secondry to increased left artrial pressure
• Precipated by tachycardia and increased heart volume
• Arrythmias
• Thromoboembolism
• Stroke
• Cardiac arrest
• Maternal Death
• Complication rate is related with severity of mitral
stenosis
Fetal outcome:

• Preterm birth
• IUGR
• Low birth Weight
• Fetal or neonatal death
Managment :
• History : obstetric cardiac and family history
• Physical examination:
.GPE :- pallor (exclude anemia)
Thyroid
Pedal edema
JVP
BMI
BP
Pulse ( Rhythm rate )
Systemic examination
Chest ( basal crepts) , pulmonary edema
Heart --- Any murmur
P/A
exclude IUGR
Investigation
• Routine Baseline
• ECG shows broad notched P waves and right axis
deviation
• Chest X ray shows a small heart with straightening
of left heart border
confirmed diagnosis by transthoracic
echocardiography
Fetal Tests :

• Dating scan
• Anomaly scan
• Fetal echocardiogram to rule out congenital heart
disease
Managment :
• Medical managment
• Avoid tachycardia put on prophylactic B- Blocker
• Tab inderal 20mg * TDS till delivery
• If associated with atrial fibrillation then Start
Thromboprophylaxis
• Inj heparin 5000IU S/C TDS till delivery and start
degoxin
Surgical managment :

• If medical therapy fails

• Sever mitral stenosis
• Balloon mitral valvotomy may be safely and
successfully used in pregnancy
• Closed Valvotomy : fetal mortality 5-15% maternal
mortality 3%
• Open valvotomy : fetal mortality 15- 33%
• Maternal mortality : 3%
• In event of pulmonary Edema
• Patient should be sat up
• Oxygen should be given
IV furosemide 20mg administrated
Degoxin only used if artrial fibrillation occurs
Care during labour:

• Avoid supine and lithotomy position

• Prevent Tachycardia during labour
• Fluid overload must be avoided even in oligouria
• epidural analgesia is suitable for patient with mitral
stenosis
• Limitation of maternal effort with an intrumental
delivery during second stage of labour to reduce
valsalva efforts