Pregnancy maternal fetal outcomes among pregnancies complicated with atrioventricular block

Abstract

Background Atrioventricular block (AVB) during pregnancy is rare. Case study for pregnancy with AVB have been reported but a consensus guideline for peripartum management has not been established. This study aimed to investigate cardiac and obstetric complications and outcomes in our pregnant women with AVB and share our management experience. Methods This was a retrospective study. We reviewed a total of 74 pregnant women with AVB who delivered at our tertiary care center in the past 10 years. The patients were categorized into four groups according to the degree of block. The data were analyzed and compared among the four groups of patients. Results Regarding the cardiac complications, the cardiac function level showed significant difference among patient groups. The higher NYHA class were observed in patients with higher degree AVB. Pacemaker was placed before delivery in 32/33 patients with III° AVB, 8/25 patients with II° AVB, and 0/16 patient with I° AVB. Other types of arrhythmias except AVB were present in all groups of patients but more frequently observed in type I patients with II° AVB. No other heart abnormalities were observed among the patient groups. Obstetric complications were found in 21 women (28.4%), including premature labor, premature rupture of membranes (PROM), gestational diabetes mellitus (GDM), preeclampsia, etc. The incidence rate of fetal cardiac abnormalities was 6.58%. But no statistical difference was detected among four groups of patients for fetal and maternal complications and fetal cardiac abnormalities (P>0.05). Caesarean section was performed more in patients with high-degree AVB than in patients with low-degree AVB. No maternal or neonatal death in our cases. Conclusions Most women with AVB could achieve successful pregnancy and delivery. Patients with II° AVB type II and III° AVB should be monitored vigilantly during pregnancy and post-partum. Temporary pacing before delivery appeared to be beneficial for women with III°AVB, and accurate diagnosis and care by a multidisciplinary team was recommended.

Pregnancy outcomes in patients complicated with pre-excitation syndrome

“…The distribution of blood loss is presented as the median ± interquartile range (IQR) and was compared using Mann-Whitney U test. These statistical methods have also been used in our other studies on pregnancy complicated with heart disease [7]. We used SPSS version 25.0 software (IBM Corp, Armonk, NY, USA) for all statistical analysis, and alpha = 0.05 was used as the cutoff for statistical signi cance.…”

“…Pre-excitation syndrome is a collective term that refers to premature ventricular activation through accessory or anomalous conduction pathways. 1,7 WPW, a classic subtype of pre-excitation, is characterized by the presence of a short PR interval and a broad QRS with a delta wave on ECG, whereas the LGL subtype only shows a short PR interval and a normal QRS complex on ECG. 8,9 Ventricular preexcitation can predispose pregnant women to re-entry arrhythmias, with clinical manifestations of pre-excitation, paroxysmal tachycardia, and related symptoms, including palpitations, dizziness, and/or syncope.…”

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“…The dysfunction of cardiac electroconducting pathway results in an atrioventricular block characterized by a prolonged PR interval. These blocks are classified into three types based on the pattern and characteristics of the disruption in electrical activity: first-degree, second-degree (Mobitz type 1 or 2), and third-degree (complete AV block) [1]. Complete or total heart block is an aberrant heart rhythm with no electrical impulse conduction through the atrioventricular (AV) node, resulting in complete dissociation between the atria and ventricles.…”

“…Bradycardia may worsen during labor when uterine contractions displace blood into the central circulation. Serious cardiac and obstetric issues might arise, affecting both the mother and the fetus [1]. The mode of delivery was determined based on obstetric indications.…”

Managing a Pseudo-Mobitz Type II Atrioventricular (AV) Block Intrapartum: A Case Report

“…Currently, there is no consensus or guidelines available to manage patients with AV block during pregnancy. Most of the time, pseudo-Mobitz type II will be treated conservatively [ 4 ]. Recognizing a vagal-mediated AV block intrapartum is important, as it will help management during labor and avoid unnecessary intervention.…”