Rheumatic Heart Disease Post Mitral Valvotomy Paves the Way to Safe Motherhood

The postpartum period is a critical time for reassessing the patients with rheumatic heart disease (RHD) who have undergone balloon mitral valvotomy. This case study presents the management of a 25-year-old pregnant woman with a history of rheumatic heart disease and severe mitral stenosis, who underwent balloon mitral valvotomy nine years ago. At 31+4 weeks of gestation, she presented with bleeding and a posterior low-lying placenta. Despite being asymptomatic, her non-compliance with antibiotic prophylaxis led to complications, including heart failure postpartum. A multidisciplinary team ensured a successful emergency caesarean delivery and stabilized her condition. This study highlights the importance of vigilant, multidisciplinary care for pregnant women with cardiac conditions and the need for timely interventions to reduce maternal and fetal morbidity. Following an emergency caesarean section in view of antepartum hemorrhage, the patient developed symptoms of left heart failure on postoperative day 4. Patient was managed with medications and close monitoring. As per cardiology team, repeat balloon mitral valvotomy was planned at six weeks postpartum. This case highlights the importance of vigilant, multidisciplinary care throughout pregnancy and the postpartum period for women with RHD, as well as timely interventions to reduce maternal and fetal morbidity and mortality. Repeated regular cardiology evaluation and antibiotic prophylaxis in antenatal period are crucial. Early detection and management of complications like pulmonary edema, arrhythmias, and heart failure are essential to ensure positive outcomes for both mother and child.