This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Medical, surgical and gynaecological illness complicating pregnancy, Subject name: Gynaecology & Obstetrics
Patients with organic hea disease in pregnancy most commonly die during 
Select and explain. 
A. 20-24 weeks of pregnancy, B. First stage of labour, C. Soon following delivery, D. Two weeks postpaum
C: Soon following delivery
Answer: C: Soon following delivery 
Explanation: Maternal moality in Hea disease complicatin Pregnancy Maternal moality is lowest with rheumatic hea lesions and acyanotic group of hea diseases ie <1% With the elevation of pulmonary vascular resistance especially with cyanotic hea diseases the moality may be raised to 50%( Eisenmengers syndrome) Most of the deaths occur due to cardiac failure and maximum deaths occurs following bih. Management Of Cardiac Failure: The principle if management is same as in the non-pregnant women. A cardiologist should be involved Propped up position O2 Adminstration Monitoring with ECG and pulse oximetry Diuretic: Frusemide (40-80mg) IV - Anticipatory aggresive diuresis is needed to avoid pulmonary congestion. Mechanical Ventilation Injection morphine 15mg IM Digoxin 0.5mg IM followed by Tab.Digoxin 0.25mg P/O Dysrhythmias -Quinidine or electrica cardiaversion Tachyarhymias -Adenosine(3-12mg) IV or DC conversion. Reference: D.C.Dutta's Textbook of Obstetrics; 9th edition; Page no: 258 & 260