Professional paper

https://doi.org/10.57140/mj.53.3.7

Management of fetal supraventricular tachyarrhythmia - case report

Zdeslav Benzon ; University Hospital of Split, Department of Obstetrics and Gynecology; University of Split, School of Medicine
Jasminka Rešić ; University Hospital of Split, Department of Obstetrics and Gynecology; University of Split, School of Medicine; University of Split, University Department of Health Studies
Zoran Meštrović ; niversity Hospital of Split, Department of Obstetrics and Gynecology; University of Split, School of Medicine
Indira Kosović ; University Hospital of Split, Department of Obstetrics and Gynecology; University of Split, School of Medicine
Sandra Benzon orcid.org/0000-0002-7911-4005 ; University Hospital of Split, Department of Obstetrics and Gynecology; University of Split, School of Medicine; University of Split, University Department of Health Studies

Abstract

The conduction system of the fetal heart is defined by the16th week of gestation when it matures and
normally produces a regular rhythm and rate between 110 and 160 beats per minute (bpm) for the remainder
of the pregnancy. Deviations from these parameters are fetal arrhythmias. They are diagnosed in 2% of
unselected pregnancies. They are mostly benign and transient but some of them are persistent and associated
with structural defects or can cause heart failure, fetal hydrops and intrauterine death. Routine prenatal care
includes screening for fetal arrhythmias in the second and third trimester with fetal ultrasound examinations
which include a view of the four cardiac chambers and both ventricular outflow tracts. The fetal outcomes
are improved upon appropriate antepartum diagnosis and care. Here we present a pregnancy and
multidisciplinary management, prenatal evaluation and intervention with maternal transplacental treatment
of a 28-year-old female, gravida II, para II, in 28+5 weeks of gestation with fetal arrhythmia, in tertiary
university hospital. She had a history of previous caesarean section, in the 40th week of gestation due to an
infection of the synus pylonidalis. We confirmed suspected fetal arrhythmia as supraventricular
tachyarrhythmia without fetal hydrops, based on the ultrasound doppler M mode imaging, and started
transplacental administration of antiarrhythmyc agent, digoxin. It has been considered the first line agent
for treatment of fetal supraventricular tachycardia but higher maternal doses are required to maintain a
therapeutic serum level. We converted fetal heartbeat into normal sinus rhythm after three days of
administration of digoxin. We continued to monitor the fetus once a week with controlling levels of digoxin
and electrolytes in maternal blood until the end of the pregnancy at 38+6 weeks of gestation.

Keywords

fetal arrythmia; prenatal diagnosis; transplacental therapy

Hrčak ID:

310176

URI

https://hrcak.srce.hr/310176

Publication date:

27.11.2023.

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