Complications of pregnancy: mitral stenosis after delivery: 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: mitral stenosis after delivery

Sample item

A woman with severe mitral stenosis delivers vaginally under epidural analgesia. Two hours later she becomes breathless with bilateral crepitations. Which mechanism best explains this?

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

The answer and the reasoning

A. Autotransfusion after uterine contraction increasing preload against a fixed valve obstruction

After delivery, the uterus contracts and relieves vena caval compression, so about 500 mL of blood returns to the circulation. In mitral stenosis the left atrium cannot empty this extra volume, and pulmonary oedema follows. The risk is highest in the first hours after delivery, so these women need close monitoring and diuretics.

Option by option

  • A. Autotransfusion after uterine contraction increasing preload against a fixed valve obstruction (correct)

    Correct. The sudden preload rise cannot pass the narrowed mitral valve.

  • B. Peripartum cardiomyopathy with a dilated left ventricle

    Peripartum cardiomyopathy appears later, in the weeks after delivery, and she has a known valve lesion.

  • C. Amniotic fluid embolism with pulmonary vasospasm

    Amniotic fluid embolism presents with collapse and coagulopathy rather than isolated pulmonary oedema soon after an uncomplicated birth.

  • D. Primary postpartum haemorrhage with hypovolaemic shock

    Haemorrhage would produce hypotension with clear lungs, not pulmonary congestion.

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 A, Autotransfusion after uterine contraction increasing preload against a fixed valve obstruction. After delivery, the uterus contracts and relieves vena caval compression, so about 500 mL of blood returns to the circulation.

Why is "Peripartum cardiomyopathy with a dilated left ventricle" not the answer?

Peripartum cardiomyopathy appears later, in the weeks after delivery, and she has a known valve lesion.

Why is "Amniotic fluid embolism with pulmonary vasospasm" not the answer?

Amniotic fluid embolism presents with collapse and coagulopathy rather than isolated pulmonary oedema soon after an uncomplicated birth.

Why is "Primary postpartum haemorrhage with hypovolaemic shock" not the answer?

Haemorrhage would produce hypotension with clear lungs, not pulmonary congestion.

What concept does this question test?

It tests Complications of pregnancy: mitral stenosis after delivery in OBG. In mitral stenosis the left atrium cannot empty this extra volume, and pulmonary oedema follows. The risk is highest in the first hours after delivery, so these women need close monitoring and diuretics.

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: mitral stenosis after delivery?

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.