Quiz: CV morbidity and mortality in pregnancy

Cardiovascular disease is one the leading causes of morbidity and mortality during pregnancy. This quiz goes over some of the important takeaways on the issues covered in Dr. Beth Brickner's article from the January 2018 issue, "Cardiovascular morbidity and mortality in pregnancy." If you need a refresher before taking the quiz, her article can be found here. The answers to each question can be found on the following page.

QUESTION 1

Correct answer: A. secundum atrial septal defect

Half of patients with CHD have a simple defect and typically tolerate pregnancy well, and half have a moderate or complex defect and may or may not tolerate pregnancy well.

QUESTION 2

Correct answer: C. hypertensive crisis

The most common maternal cardiovascular complications are arrhythmias and heart failure, but stroke, cardioembolic events, and infection may also occur. Fetal complications include spontaneous abortion, intrauterine fetal demise, preterm birth, small for gestational age, and neonatal and perinatal death.

QUESTION 3

Correct answer: B. advanced left-side valvular disease

Aortic and mitral stenosis, and particularly the latter type of advanced left-side valvular disease, can put a patient at risk for hemodynamic compromise during labor and delivery.

QUESTION 4

Correct answer: C. 58%

The author states that anticoagulation management is complex in women with mechanical values. Pregnancy induces a prothrombotic state, which increases the risk of mechanical valve thrombosis and makes it difficult to maintain stable anticoagulation.

QUESTION 5

Correct answer: A. A low risk of maternal mortality and a moderate risk of morbidity

There are four WHO Pregnancy categories: I = no significant maternal morbidity or mortality. II = a low risk of maternal mortality and a moderate risk of morbidity. III = a high risk of complications with a significantly increased risk of maternal mortality or morbidity. IV = a very high risk of maternal mortality or morbidity that contraindicates pregnancy.

QUESTION 6

Correct answer: C. 24.5%

A validation study comparing risk models for pregnancy complications in women with CHD found a risk of cardiovascular complications of 0% for WHO Class I, 6.8% for WHO Class II, 24.5% for WHO Class III, and 100% for WHO Class IV.

QUESTION 7

Correct answer: A. True

The author reports that high-risk women should be followed closely during pregnancy and after, and that a specific plan should be made for labor, delivery, and postpartum care involving the cardiologist, ob/gyn, and anesthesiologist.