Maternal complete heart block in pregnancy: Analysis of four cases and review of management

Abstract

When a multidisciplinary approach is used, both maternal and neonatal outcomes are good. The incidence of IUGR and preterm birth may be on the increase; hence, clinical vigilance for these conditions is warranted.

Pregnancy with Complete Heart Block

“…No other complication like oligohydramnios or IUGR was seen in our case; however, Mandal et al [2] reported complications like IUGR (14 %), oligohydramnios (7 %), preterm labor (11 %) in the 21 patients studied. Suri et al [4] also reported IUGR in two out of the four cases studied with absent and reversed diastolic flow leading to a preterm delivery by cesarean section. There are different opinions regarding the need for pacemaker during pregnancy.…”

“…In most of these studies, the pregnant women were asymptomatic during pregnancy except for Mandal et al [2][3][4] who reported 21 pregnant women with complete heart block and found all of them to be symptomatic syncope and palpitation seen in 29 and 38 % women, respectively. CHB does not cause any specific pregnancy-related problems except for few cases of IUGR and preterm delivery [2,4]. The patient reported here also did not have any symptoms during the antenatal period, and no pregnancy-related complication was seen.…”

“…As the patients are at risk of mortality due to unpredictable syncope, emergency resuscitative measures should always be at hand with a interventional cardiologist present all the time as bradycardia unresponsive to drugs will need immediate pacing. This is particularly important at the time of labor when the cardiac demands are more and the patient is more prone to develop syncopal attacks due to slowing of heart rate associated with Valsalva maneuver [4].…”

“…Due to the sudden onset high sympathetic blockade spinal anesthesia often results in bradycardia which may be devastating for the patients with CHB. For this reason, use of incremental epidural or lowdose combined spinal and epidural has been recommended by most of the authors for any instrumental delivery or cesarean section [2,4,5].…”

The investigation and management of broad complex tachycardia and ventricular standstill presenting in pregnancy: A case report

“…[1][2][3][4] Life-threatening arrhythmia is rarely reported in women with structurally normal hearts and few reports of atrioventricular block exist in the literature. 3,4 We present the case of a patient in her third trimester who developed non-sustained narrow and broad complex tachycardia (BCT) as well as transient ventricular standstill.…”