A 30-year-old woman presents to the clinic 17 weeks pregnant and becoming increasingly breathless. The LVEDD is 6.1 cm and the EF is estimated at 25%.
Which one of the following statements is false?
A. Termination of pregnancy is justified on medical groundsACE inhibitors are absolutely contraindicated in the second and third trimesters of pregnancy because of the risk of renal defects, oligohydramnios, and limb contractures. Hydralazine and nitrate is a safe alternative. Rest (bed rest in hospital) is likely to be required in this case. The aim would be for the fetus to reach viability without compromising the mother. Termination of pregnancy would be justified in this case as there is a high risk of pulmonary oedema, intractable heart failure, stroke, and fetal loss. Patients with occult left ventricular dysfunction and obstructive valve disease usually present around this point in gestation as this is when their increase in cardiac output and plasma volume during pregnancy begins to peak (apart from in labour). The haemodynamic changes in pregnancy are profound. Hormonally mediated increases in blood volume, red cell mass, and heart rate result in a significant increase in cardiac output. Cardiac output peaks during the second trimester, and then remains constant until term. Circulating prostaglandins and other gestational hormones, and the low-resistance vascular bed of the placenta, result in decreases in peripheral vascular resistance and blood pressure. Blood pressure reaches its nadir in the middle of the second trimester and then begins to rise again towards term.