20 year old married woman with history of congenital heart disease comes for pre-conceptional counselling. Which of the following is most likely adverse event that she might face in pregnancy
**Core Concept**
Congenital heart disease (CHD) increases the risk of adverse pregnancy outcomes due to altered hemodynamics, increased cardiac workload, and potential for cardiac decompensation. Pregnancy poses a significant challenge to women with pre-existing heart conditions, necessitating careful pre-conceptional counseling and management.
**Why the Correct Answer is Right**
In a woman with congenital heart disease, pregnancy is associated with an increased risk of cardiac complications, particularly pulmonary hypertension (PH). PH can lead to right ventricular failure, which may necessitate premature delivery or even maternal mortality. The risk of PH is higher in women with certain types of CHD, such as Eisenmenger syndrome, where a left-to-right shunt has reversed due to pulmonary vascular disease. The pathophysiology involves increased pulmonary vascular resistance, leading to right ventricular hypertrophy and eventual failure.
**Why Each Wrong Option is Incorrect**
**Option A:** Placental abruption is a possible complication of pregnancy, but it is not the most likely adverse event in a woman with congenital heart disease.
**Option B:** Fetal growth restriction (FGR) is a potential complication of placental insufficiency, but it is not directly related to the cardiac condition.
**Option C:** Preterm labor is a common complication of pregnancy, but it is not the most severe or directly related to the cardiac condition.
**Clinical Pearl / High-Yield Fact**
Women with congenital heart disease should undergo thorough cardiac evaluation before conception, including echocardiography and cardiac catheterization, to assess the severity of their condition and potential risks during pregnancy.
**Correct Answer: C. Pulmonary hypertension.**