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Congenital heart disease in pregnancy — FRCA Final MCQ

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HardObstetric AnaesthesiaCongenital heart disease in pregnancyFRCA Final

A 35-year-old woman with repaired tetralogy of Fallot attends antenatal anaesthetic clinic. She is 34 weeks pregnant, saturates 92% on air, has moderate right ventricular dysfunction on echocardiography and is planned for elective caesarean delivery. What is the most appropriate anaesthetic technique?

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Correct answer: E — Individualised neuraxial technique with invasive monitoring and congenital cardiac input

Complex congenital heart disease in pregnancy requires planned multidisciplinary care, usually including obstetric anaesthesia, cardiology, obstetrics and critical care. A carefully titrated neuraxial approach may avoid airway and myocardial stress, but monitoring and vasopressor planning are crucial. A high-dose single-shot spinal can cause abrupt sympathectomy. Late or unplanned decision-making is unsafe in a patient with hypoxaemia and ventricular dysfunction.

Reference: ESC pregnancy cardiac disease guidance; OAA high-risk obstetric anaesthesia guidance