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VOLUME 12 , ISSUE 6 ( November-December, 2020 ) > List of Articles
Suniti J Rawal, Prabhat Khakural
Keywords : Complete heart block, Pacemaker, Pregnancy
Citation Information : Rawal SJ, Khakural P. Challenges in Managing Pregnancy with Complete Heart Block and Its Outcome in a Tertiary Center in Nepal. J South Asian Feder Obs Gynae 2020; 12 (6):359-362.
License: CC BY-NC 4.0
Published Online: 12-04-2021
Copyright Statement: Copyright © 2020; The Author(s).
Aim: Various congenital and acquired causes can lead to abnormal conduction of electrical impulses from atria to ventricles, resulting in complete atrioventricular dissociation. Such complete heart blocks (CHBs) are uncommon in pregnant women. However, when diagnosed in pregnancy, the management remains challenging. Here, we share our experience of managing patients with CHB diagnosed in pregnancy and their outcome. Materials and methods: A retrospective review of women diagnosed with CHB during pregnancy and managed in the Department of Obstetrics and Gynecology, Tribhuvan University Teaching Hospital, and in Manmohan Cardiothoracic and Vascular Center, from April 2016 to March 2020, was done. Data studied from case records included history, clinical examination, 12-lead electrocardiogram, echocardiogram, 24-hour Holter study, exercise tolerance, response to chronotropic drugs, and antenatal follow-up. Mode of delivery, need for pacing, and maternal and fetal outcomes were evaluated. Results: Six women had CHB diagnosed between 22 and 40 weeks’ gestation of index pregnancy. The mean age of the patients was 25.8 ± 5.1 years. The heart rate at diagnosis was between 40 and 48 bpm. None of the patients had any symptoms or abnormal echocardiography. Fifty percent had vaginal delivery. All of the patients had an uneventful peripartum period and none had any emergency indication for pacing. The mean birth weight of the babies was 2485.7 ± 389 g and two of them had intrauterine growth retardation. None of the babies had any conduction or cardiac structural abnormalities. Conclusion: Close monitoring, periodic follow-up, and vigilant management by a multidisciplinary team of obstetricians, cardiologists, anesthetists, and pediatricians in a center with the facility of insertion of a cardiac pacemaker can ensure a good maternal and fetal outcome in pregnant women with CHB. Clinical significance: Asymptomatic CHB in pregnancy can be managed conservatively without pacing.