ABSTRACT
Severe symptomatic MS is associated with significant adverse maternal and foetal outcomes. Thus, it is considered as a contraindication for pregnancy before relief of obstruction by an appropriate intervention. When pregnant patients present with MS, the care should be provided at a centre with adequate experience and availability of cardiologist, expert obstetrician and anaesthetist. Medical management with diuretics and beta blockers remain first line with intervention reserved for patients with severe symptoms (NYHA class III or IV) despite adequate medical management. Risk of foetal adverse outcomes remains high with surgical interventions and PTMC has been shown to be safe and effective in multiple case series with the best time to perform PTMC being early second trimester. Caesarean section should be reserved for obstetric indications and regional anaesthesia and assisted delivery should be considered during the progress of labour.
