Obstetric aspects The principles of obstetric
management of patients with rheumatic heart
disease do not differ greatly from those of general
obstetric practice. The patients should be suitably
sedated at the onset of labour and during the first
stage and kept in the propped-up position as far as
possible. The second stage should be shortened by
forceps delivery when appropriate.
Prevailing opinion is that caesarian section should
as a rule only be carried out for obstetric reasons.
Opinions are still divided on the use of ergometrine.
On the whole, it should be used sparingly as
it can precipitate acute pulmonary oedema in the
presence of mitral stenosis.
As there is evidence that the administration of
stilboestrol for the suppression of lactation after
delivery is associated with an increased incidence of
Pregnancy and rheumatic heart disease 1303
thrombophlebitis and pulmonary embolism (Daniel,
Campbell, and Turnbull, i967), it should not be
used in patients with rheumatic heart disease, if at
all.
We are grateful to Professor R. J. Kellar for permission
to quote from the Annual Reports of the Simpson
Memorial Maternity Pavilion, Edinburgh.