This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: All India exam, Subject name: Pathology
Pt with mitral stenosis in labour wants analgesia for normal delivery. Which form of Anaesthesia to be used for her? 
Select and explain. 
A. Inhalational Anaesthesia, B. Spinal Anaesthesia, C. Epidural Anaesthesia, D. Opioids
C: Epidural Anaesthesia
Answer: C: Epidural Anaesthesia 
Explanation: Epidural anesthesia during PregnancyCombined spinal-epidural analgesia during labour using intrathecal fentanyl 25 mcg produces good analgesia without major hemodynamic changes during the first stage of labour. During the second stage of labour, only the uterine contractile force should be allowed rather than the maternal expulsive effo that is always associated with the Valsalva maneuver. Therefore, the second stage of delivery should be cut sho by instrumentation. Supplementary analgesia for instrumentation with slow epidural boluses of fentanyl and a low concentration of bupivacaine reduces SVR and the cardiac pre-load.One of the major advantages of epidural analgesia is that it can be administered in incremental doses and that the total dose could be titrated to the desired sensory level.This coupled with the slower onset of anesthesia, allows the maternal cardiovascular system to compensate for the occurrence of sympathetic blockade, resulting in a lower risk of hypotension and decreased uteroplacental perfusion.Moreover, the segmental blockade spares the lower extremity "muscle pump," aiding in venous return, and also decreases the incidence of thromboembolic events. Invasive hemodynamic monitoring, judicious intravenous administration of crystalloid and administration of small bolus doses of phenylephrine maintain maternal hemodynamic stability.(Refer: William's Obstetrics, 22nd edition, pg no: 483)