Cardiovascular Conditions in Pregnancy MCQs

Protocol for management of H. mole Prophylactic chemotherapy: Routine prophylactic chemotherapy is not advocated now at all. Earlier in the following conditions chemotherapy was given. Conditions: Initial high levels of b-hCG (> 100,000 mIU/ml) Elevation of serum hCG at 4–6 weeks or hCG values fail to come back to normal by stipulated truth (10-12 weeks). Evidence of metastasis irrespective of hCG levels. Age of patient > 35 years. Theca lutein cyst 6 cm Post evacuation hemorrhage. Drug used : Methotrexate/Actinomycin D is given for 5 days. Reference: Dutta Obs. 7/e, p 200, 196; COGDT 10/e, p 890; Shaw 14/e, p 231

Venous thromboembolism in pregnancy Venous thromboembolism is the leading cause of maternal deaths in developed countries. Investigations Recommended method during pregnancy: Doppler ultrasound Gold standard (in conditions other than pregnancy): Venography Though objective evidence is ideal, treatment should be started on clinical grounds, if confirmatory tests are not available. Management For postpartum venous thrombosis, treatment with i/v heparin and warfarin are started simultaneously 6-8 hours after vaginal delivery and 24 hours after cesarean section and once INR is between 2 and 3, heparin is discontinued and warfarin is continued for 6 weeks. Note: Warfarin is absolutely safe in lactation. Reference : Williams 23/e, pg 1028, 29, Table 47.6

This is another way of asking, cardiac failure occurs most commonly at what time as the M/C cause of death in pregnant females with heart disease is congestive heart failure. Reference: Dutta Obs 7/e, p 225

Clear cell adenocarcinoma of vagina- Primary vaginal adenocarcinoma is rare. This is found in adolescent girls who have had history of intrauterine exposure to diethylstilbestrol in the first trimester of pregnancy. The approximate risk of an offspring to develop the clear cell adenocarcinoma of the vagina following DES exposure is 1 in 1000 or less. These patients are more likely to develop vaginal adenosis but rarely clear cell adenocarcinoma. The lesion usually involves the upper-third of the anterior vaginal wall. The cervix may also be involved. Treatment: Radical hysterectomy, vaginectomy with pelvic lymphadenectomy is the treatment of choice. Radiotherapy is reserved for advanced cases. Reference : Dutta Gynae 6 th /ed pg 339