Management of ischemic heart disease in pregnancy often includes which strategy regarding delivery?

• A. Delay delivery for more than two weeks while avoiding tachycardia and hypertension
• B. Deliver immediately at diagnosis
• C. Deliver only by cesarean section at 34 weeks
• D. Induce labor to shorten postpartum

Answer: (A)

In ischemic heart disease during pregnancy, the goal is to minimize the heart’s oxygen demand and protect the mother from the hemodynamic stress of labor and delivery. Delaying delivery for more than two weeks while carefully stabilizing the patient allows time to optimize medical therapy, control heart rate and blood pressure, and reduce the risk of ischemia or heart failure. By avoiding tachycardia and hypertension, you limit myocardial oxygen consumption and prevent stress on the ischemic myocardium. When delivery is pursued, the approach is typically planned and controlled (often vaginal delivery with regional anesthesia) to maintain steady hemodynamics, rather than forcing an early or emergency delivery.

Delivering immediately at diagnosis would impose sudden cardiovascular stress; delivering only by cesarean at 34 weeks is not routinely indicated and exposes the mother to surgical risks and preterm complications; inducing labor to shorten postpartum also increases the heart’s workload during labor. If the mother remains stable and fetal maturity allows, postponing delivery with careful management is the preferable strategy.