Resolution of tachyarrhythmia-related fetal hydrops after corticosteroid administration for fetal lung maturation

Abstract

A case of hydrops fetalis (HF) that resolved after corticosteroid therapy despite persisting fetal tachycardia of 190 bpm is reported. The fetus with confirmed normal karyotype had HF in the presence of atrial flutter and sustained ventricular rate of 200-210 bpm at gestational week (GW) 31(-6/7). Aetiologies of HF other than fetal tachyarrhythmia were unlikely in this infant. The patient's family declined pharmacological treatment with maternal digoxin and desired to continue pregnancy with only intensive monitoring of fetal condition. Maternal transplacental β-methasone was given to facilitate fetal lung maturation. The fetal tachyarrhythmia ameliorated to 190 bpm at GW 32(-5/7) and HF gradually disappeared by birth. The otherwise healthy female neonate weighing 3050 g born at GW 37(-0/7) was successfully treated with cardioversion performed 60 min after birth. This case suggested that corticosteroid therapy contributed to the resolution of HF associated with tachyarrhythmia.

Cardiac Arrhythmias Requiring Electric Countershock during the Neonatal Period—A Systematic Review

“…Thirty-four articles (87.2%) [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 ] stated the patients’ gestational ages. The described neonates ranged from 25 +2 to 40 +4 weeks of gestation.…”

“…In 22 articles (56.4%) [ 7 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ] including 39 neonates (34.5%), rhythm disturbances were diagnosed immediately or within the first hours after birth. In 6 articles (15.4%) [ 8 , 34 , 35 , 36 , 37 , 38 ] the 62 described neonates (54.9%) were classified into an age group between birth and four weeks post-partum.…”

“…In 15 studies (38.5%) [ 7 , 8 , 14 , 15 , 16 , 17 , 20 , 22 , 23 , 26 , 28 , 29 , 32 , 34 , 35 ] including 33 neonates (29.2%), arrhythmias had already been detected prenatally or were the reason for inducing labor [ 22 , 23 ].…”

Successful management of fetal atrial flutter at term pregnancy with postnatal electrocardioversion

“…The commonly used antiarrhythmic drugs include digoxin as first choice and sotalol, flecainide, amiodarone, verapamil, procainamide as second choice. 2,11 Studies show that there is a significantly better response to sinus rhythm prenatally when digoxin is used in nonhydropic fetuses (80%), compared with 43% in hydropic fetuses. 8,12 It is important to remember that spontaneous conversion to sinus rhythm sometimes happen in fetal AF postnatally, although this was not observed in our case.…”

Successful management of fetal atrial flutter at term pregnancy with postnatal electrocardioversion.

“…The commonly used antiarrhythmic drugs include digoxin as first choice and sotalol, flecainide, amiodarone, verapamil, procainamide as second choice. 2,11 Studies show that there is a significantly better response to sinus rhythm prenatally when digoxin is used in non-hydropic foetuses (80%), compared with 43% in hydropic foetuses. 8,12 It is important to remember that spontaneous conversion to sinus rhythm does happen in fetal AF postnatally, although this was not observed in our case.…”