حامل عمرها ٣١ سنة في الأسبوع ٣٠، عندها تضيق في الصمام التاجي من حمى روماتيزمية، ومستقرة على علاجها. نبضها ٩٢ وضغطها ١١٠/٦٨، وتسأل الممرض عن أخطر وقت عليها. متى تكون أعلى خطورة للحمل الزائد على القلب حول الولادة؟

A 31-year-old woman at 30 weeks’ gestation has rheumatic mitral stenosis and is stable on treatment. HR 92, BP 110/68; she asks when she is at greatest risk. When is cardiac volume overload highest around delivery?

1. In early pregnancy before blood volume rises
2. Right after delivery, as uterine blood returns to the circulation
3. Only in the first trimester because of nausea and vomiting
4. Three months after birth when breastfeeding begins

Answer: B) Right after delivery, as uterine blood returns to the circulation. Blood volume peaks late in pregnancy, and right after delivery the uterine blood returns to the circulation and cardiac load rises sharply. Cardiac patients are monitored closely in the first hours and days after birth.