Introduction Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a genetic disorder that can cause fatal tachyarrhythmias brought on by physical or emotional stress. There is little reported in the literature regarding management of CPVT in pregnancy much less during labor. Case presentation A gravida 2, para 1 presented to our high-risk clinic at 15 weeks gestation with known CPVT. The Caucasian female patient had been diagnosed after experiencing a cardiac arrest following a motor vehicle accident and found to have a pathogenic cardiac ryanodine receptor mutation. An implantable cardioverter defibrillator was placed at that time. Her pregnancy was uncomplicated, and she was medically managed with metoprolol, flecainide, and verapamil. Her labor course and successful vaginal delivery were uncomplicated and involved a multidisciplinary team comprising specialists in electrophysiology, maternal fetal medicine, anesthesiology, general obstetrics, lactation, and neonatology. Conclusions CPVT is likely underdiagnosed and, given that cardiovascular disease is a leading cause of death in pregnancy, it is important to bring further awareness to the diagnosis and management of this inherited arrhythmia syndrome in pregnancy.

INTRODUCTION: Little contemporary data are available on pregnancy delivery and neonatal outcomes in a diverse population of very advanced maternal age, defined as age 40 years or greater at estimated date of delivery (EDD). We examined the association of adverse delivery and neonatal outcomes in women at very advanced maternal age from 2016 to 2017. METHODS: This retrospective cohort study examined patients presenting for delivery in an urban academic healthcare system from 2016 to 2017. Women 40 years old or older at EDD (n=433) were compared with controls age 25-30 years (n=755). The primary outcome compared rates of cesarean delivery between the two groups. Differences in delivery and neonatal outcomes were also examined. Chi-square and Fisher exact tests were used for categorical variables; Wilcoxon rank-sum test was used for continuous variables. Logistic regression was used adjust for any demographics that were associated with age. RESULTS: Women age 40 or older were more likely to deliver via cesarean section than younger controls even after adjusting for demographic differences (42.7% vs 31.1%, adjusted P<.001). Secondary outcomes also identified significant associations between very advanced maternal age and an earlier gestational age at delivery (P<.001), as well as neonatal anomalies identified at birth, NICU admission and infant length of stay (all P<.05). CONCLUSION: Very advanced maternal age is associated with an increased risk of cesarean section, as well as an increased risk of additional delivery and neonatal complications. Prospective research is needed to determine whether these risks might be modifiable with changes in current obstetric management.