"Mitral stenosis is the valve lesion that pregnancy punishes most — a fixed valve meets a rising blood volume, a faster heart and a falling SVR. This topic is split into short, focused tabs; read them in order or jump to what you need."
How to use this topic — CritCare.in.Mitral Stenosis in Pregnancy for Caesarean Section
"Mitral stenosis is the valve lesion that pregnancy punishes most. A fixed, narrowed valve meets a 50% rise in blood volume, a rise in heart rate and a fall in systemic vascular resistance — the very changes a stenotic mitral valve cannot accommodate — and the parturient tips into pulmonary oedema. The anaesthetic goal is a slow, full, well-controlled circulation."
Synthesised from Stoelting's Co-Existing Disease & Chestnut's Obstetric Anesthesia.A 24-year-old primigravida at ~35 weeks, a known case of mitral stenosis, planned for elective lower-segment caesarean section (LSCS) (a classic DrNB long case — June 2019 Paper 3). The principles below apply to any parturient with significant MS.
- MS is a fixed obstruction to left-ventricular filling. Anything that shortens diastole (tachycardia), drops preload, or raises pulmonary vascular resistance is dangerous. Aim to keep the patient slow, in sinus rhythm, adequately filled, and free of rises in PVR.
Pathophysiology & Pregnancy
The fixed obstruction to LV filling, the atrial kick, AF & pulmonary hypertension — and how pregnancy aggravates MS.
🔎02 · ASSESSMENTAssessment & Severity
Symptoms, signs (loud S₁, opening snap, mid-diastolic murmur, loud P₂), ECG/echo/CXR and the grades of MS.
🎯03 · GOALSAnaesthetic Management Goals
Maintain preload & SVR, avoid tachycardia, keep sinus rhythm, avoid ↑ PVR & aortocaval compression; monitoring.
💉04 · TECHNIQUEAnaesthetic Options for LSCS
The graded epidural of choice, why single-shot spinal is avoided, and GA for NYHA III–IV.
🍼05 · DELIVERY & POST-OPOxytocics & Recovery
Dilute oxytocin (never bolus), avoid ergometrine, and HDU care through the high-risk autotransfusion window.
🎓06 · PEARLSMistakes, Pearls & References
Common mistakes, viva-ready exam pearls and references.