Page 1 of 1: gynae-A 25 years old woman with rheumatic mitral

BRAVO · Credits: 46338 Preparing for: MRCS Part 1 My Scrapbook

A 25 years old woman with rheumatic mitral stenosis reports at 12 weeks gestation. As per her management plan, she requires balloon valvuloplasty. The best time to carry it out will be:

a) Immediately
b) 16 weeks
c) 28 weeks
d) 32 weeks

draditithegreat · Credits: 1248083 My Scrapbook

immediately........

jgsharon · Credits: 9735 Preparing for: General My Scrapbook

Will it not be in the 2nd trimester..........at 16

weeks?

parin · Credits: 14996 My Scrapbook

16 weeks...

Dutta: best time for surgery is b/w 14-18 weeks....

nazia_k · Credits: 2934 Preparing for: Canada My Scrapbook

at 16 weeks

dr_nidhi · Credits: 13396 My Scrapbook

it is 16 weeks...

ekhlas · Credits: 110 My Scrapbook

Immediately

mjg · Credits: 312 Preparing for: DNB Part 1 My Scrapbook

its in second trimister

drjanak · Credits: 3401 My Scrapbook

Williams Obstetrics 22ed 2005 - Chapter on Medical & Surgical Complications - General Considerations & Maternal Evaluation

"The implications of these findings seem straightforward. At 8 to 15 weeks, the embryo is most susceptible to radiation-induced mental retardation. This risk is probably a nonthreshold linear function of dose, with the risk of severe mental retardation being as low as 4 percent for 10 rad and as high as 60 percent for 150 rad (Committee on Biological Effects, 1990). These doses are 10 to 100 times higher than those from diagnostic radiation. However, cumulative doses from multiple procedures may enter that harmful range, especially at 8 to 15 weeks. At 16 to 25 weeks, the risk is less, and there is no proven risk before 8 weeks or after 25 weeks.
Dosimetry calculations for fluoroscopy and angiography are much more difficult because of variations in the number of radiographs obtained, fluoroscopy time, and the amount of fluoroscopy time the fetus is in the radiation field.

special-purpose systems such as angiography units have potential for much higher exposure."

Williams Obstetrics 22ed 2005 - Chapter on Medical & Surgical Complications
"Because significant hemodynamic alterations are apparent early in pregnancy, women with severe cardiac dysfunction may experience worsening of heart failure before midpregnancy. In others, heart failure develops after 28 weeks, when pregnancy-induced hypervolemia is maximal"

There is no clear cut mention of "ideal" time for balloon valvuloplasty in Williams. But going by radiation concerns 16-25 weeks is the best time and going by tendency to heartfailure after 28 weeks, the answer should be 16 weeks.

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