Complications of pregnancy: modified WHO class IV cardiac disease: practice question

A OBG question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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OBG · Complications of pregnancy: modified WHO class IV cardiac disease

Sample item

A 24-year-old woman with a known large atrial septal defect and Eisenmenger syndrome presents at 8 weeks of gestation. She is cyanosed with oxygen saturation of 84 percent. How should her pregnancy be classified and counselled?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Modified WHO class IV: pregnancy carries extremely high maternal risk and is contraindicated, so termination should be offered

Pulmonary arterial hypertension of any cause, including Eisenmenger syndrome, falls in modified WHO class IV, where maternal mortality is very high. Pregnancy is contraindicated and termination should be offered, ideally with multidisciplinary care. If the woman continues, she needs delivery in a tertiary centre.

Option by option

  • A. Modified WHO class I: no extra surveillance, as the shunt will reverse during pregnancy

    Fall in systemic vascular resistance in pregnancy worsens right-to-left shunting, so the lesion deteriorates and does not improve.

  • B. Modified WHO class III: continue with monthly review and plan elective caesarean at 38 weeks

    Class III is a high but not prohibitive risk category and does not include pulmonary arterial hypertension.

  • C. Modified WHO class II: low risk, routine antenatal care with a cardiology review once a trimester

    Class II covers small uncomplicated lesions, not pulmonary hypertension with cyanosis.

  • D. Modified WHO class IV: pregnancy carries extremely high maternal risk and is contraindicated, so termination should be offered (correct)

    Correct. Eisenmenger syndrome is a class IV condition in which pregnancy is contraindicated.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this OBG question

What is the answer to this OBG question?

The best answer is D, Modified WHO class IV: pregnancy carries extremely high maternal risk and is contraindicated, so termination should be offered. Pulmonary arterial hypertension of any cause, including Eisenmenger syndrome, falls in modified WHO class IV, where maternal mortality is very high.

Why is "Modified WHO class I: no extra surveillance, as the shunt will revers…" not the answer?

Fall in systemic vascular resistance in pregnancy worsens right-to-left shunting, so the lesion deteriorates and does not improve.

Why is "Modified WHO class III: continue with monthly review and plan electiv…" not the answer?

Class III is a high but not prohibitive risk category and does not include pulmonary arterial hypertension.

Why is "Modified WHO class II: low risk, routine antenatal care with a cardio…" not the answer?

Class II covers small uncomplicated lesions, not pulmonary hypertension with cyanosis.

What concept does this question test?

It tests Complications of pregnancy: modified WHO class IV cardiac disease in OBG. Pregnancy is contraindicated and termination should be offered, ideally with multidisciplinary care. If the woman continues, she needs delivery in a tertiary centre.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Complications of pregnancy: modified WHO class IV cardiac disease?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.