Diagnostic and Perinatal Management of Fetal Extrasystole

Abstract

Fifty fetuses referred to the Polish Mother's Memorial Hospital for fetal echocardiography between January 1, 1991 and June 1, 1995 were evaluated. The mean fetal gestational age at the time of diagnosis of arrhythmia was 34.1 weeks, and the mean gestational age at the time of delivery was 38.7 weeks. Checkup echocardiographic examinations were performed every 10-14 days, for a mean 2.4 studies per fetus. In most cases (48/50, 96%), premature atrial contractions were present during the first echocardiography examination. The fetal heart study was normal in 30 cases; in 7 (14%) there was tricuspid valve regurgitation, in 7 (14%) an atrial septal aneurysm, in 4 congenital heart defects, in 1 myocardial hypertrophy, and in 1 disproportion in the four-chamber view. Of the 50 fetuses, 43 underwent regular echocardiographic monitoring alone; in 7 cases, based on the presence of additional echocardiographic findings, pharmacotherapy was applied (digoxin, verapamil, or both). Three neonates died after delivery owing to malformations in two cases (one critical aortic stenosis, one spina bifida plus hygroma colli) and due to myocarditis in one case. In six of seven newborns treated in utero, myocarditis was diagnosed after birth (including the one with neonatal demise). Most of the newborns were in good condition after birth, their mean Apgar score being 8.6 and the mean birth weight 3259 g. We concluded that most extrasystoles represent an isolated anomaly, not affecting the fetal condition. Their presence should not influence the obstetric care and may require only echocardiographic monitoring. In most of our cases the premature contractions subsided after birth, although sometimes they preceded fetal supraventricular tachycardia or appeared after congenital myocarditis.

Guidelines for fetal echocardiography

“…Continuous monitoring is unnecessary in cases of sporadic premature atrial contraction without cardiac malformation, but tachycardia may subsequently develop in rare cases . If fetal movement decreases, further examinations should be performed.…”

“…Continuous monitoring is unnecessary in cases of sporadic premature atrial contraction without cardiac malformation, but tachycardia may subsequently develop in rare cases. 77 If fetal movement decreases, further examinations should be performed. When premature atrial contractions occur frequently (≥10/min), a level II examination should be conducted in order to distinguish between monofocal and multifocal atrial tachycardias.…”

Fetal cardiac arrhythmia during bupropion use

“…Prolonged bradycardia in the fetus may lead to asphyxia and prolonged tachyarrhythmia to cardiovascular failure. Maternal abstinence from caffeine, alcohol and nicotine intake and/or other potential inciting agents is often suggested (4). Bupropion is currently labeled pregnancy category C by the Food and Drug Administration in the USA; however, there is a paucity of data on its safety.…”

Langzeitoutcome von Kindern mit pränatal diagnostizierter supraventrikulärer Extrasystolie

“…Eine ähnliche Inzidenz berichtenRespondek et al (1997), die bei 8% von 50 Feten mit SVES oder VES einen Herzfehler fanden[15]. Jedoch fanden sie bei jeweils weiteren 14 % der Feten eine Trikuspidalinsuffizienz oder ein Vorhofseptumaneurysma, welche nicht als Fehlbildungen gewertet wurden.…”

“…Ein Problem beim Vergleich verschiedener Studien ergibt sich durch die unterschiedlichen Definitionen von Fehlbildungen. So wurde beispielsweise ein PFO, das den häufigsten postnatalen Herzfehler in unserer Studie ausmacht, in anderen Studien nicht als Herzfehler gewertet[15]. Andere Studien untersuchen postnatal nur solche Herzfehler, die auch pränatal zu diagnostizieren sind, obwohl ein PFO oder ein persistierender Ductus arteriosus die häufigsten Herzfehler bei Neugeborenen darstellen (53 % bzw.…”