A 36-year-old primigravid woman at 36 weeks' gestation comes to the physician for a prenatal visit. She is experiencing good fetal movement and has had no loss of fluid, bleeding from the vagina, or contractions. She has no complaints. Her past medical history is significant for mitral stenosis, which she developed after an episode of rheumatic fever as a child. She also has asthma for which she uses an albuterol inhaler daily. She has herpes outbreaks approximately once a year. At her last visit she was found to be positive for Group B Streptococcus colonization. For which of the following disease processes would this patient benefit by having a forceps-assisted vaginal delivery at the time of delivery?
Ans:D.)Mitral Stenosis. Mitral valve stenosis is one of the more common valvular lesions seen in pregnancy. The most common cause of mitral stenosis is rheumatic endocarditis. During normal pregnancy there is an increase in the cardiac output and an increase in preload and circulating volume. Patients with mitral stenosis have a fixed, decreased valve area, which places them at risk for the development of pulmonary hypeension and pulmonary edemA. Control of arrhythmias is absolutely essential in these patients because they are at increased risk, given the left atrial enlargement that often goes along with their mitral stenosis. Labor and delivery can be a paicularly dangerous time for these patients. Therefore, patients with significant mitral stenosis should be monitored invasively using a Swan-Ganz catheter. It is recommended that the second stage of labor be shoened using forceps or vacuum to prevent excess maternal Valsalva effos and maternal tachycardia. Asthma ( Choice A)is not an indication for forceps-assisted vaginal delivery. In terms of mode of delivery, asthmatic patients may be managed like any other patient in the second stage of labor. Group B Streptococcus colonization (Choice B) is an indication for intravenous penicillin or clindamycin (if the patient has an allergy to penicillin). These antibiotics are given to prevent GBS sepsis in the neonate. GBS colonization is not an indication for forceps-assisted vaginal delivery. Herpes (Choice C) can be transmitted to the fetus at the time of delivery. Therefore, when lesions are present in the bih canal, most obstetricians recommend cesarean delivery.
Asthma
Group B Streptococcus (GBS) colonization
Herpes
Mitral stenosis