Journal of South Asian Federation of Obstetrics and Gynaecology

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VOLUME 12 , ISSUE 6 ( November-December, 2020 ) > List of Articles

Original Article

Challenges in Managing Pregnancy with Complete Heart Block and Its Outcome in a Tertiary Center in Nepal

Pooja Paudyal, Suniti J Rawal, Prabhat Khakural

Keywords : Complete heart block, Pacemaker, Pregnancy

Citation Information : Paudyal P, 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.

DOI: 10.5005/jp-journals-10006-1834

License: CC BY-NC 4.0

Published Online: 12-04-2021

Copyright Statement:  Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

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.


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  1. Suri V, Keepanasseril A, Aggarwal N, et al. Maternal complete heart block in pregnancy: analysis of four cases and review of management. J Obstet Gynaecol Res 2009;35(3):434–437. DOI: 10.1111/j.1447-0756.2008.00961.x.
  2. Mandal S, Mandal D, Sarkar A, et al. Complete heart block and pregnancy outcome: an analysis from Eastern India. SOJ Gynaecol Obstet Womens Health 2015;1(1):5. DOI: 10.15226/2381-2915/1/1/00104.
  3. Michaëlsson M, Jonzon A, Riesenfeld T. Isolated congenital complete atrioventricular block in adult life. A prospective study. Circulation 1995;92(3):442–449. DOI: 10.1161/01.cir.92.3.442.
  4. Hidaka N, Chiba Y, Kurita T, et al. Is intrapartum temporary pacing required for women with complete atrioventricular block? An analysis of seven cases. BJOG 2006;113(5):605–607. DOI: 10.1111/j.1471-0528.2006.00888.x.
  5. Hidaka N, Chiba Y, Fukushima K, et al. Pregnant women with complete atrioventricular block: perinatal risks and review of management. Pacing Clin Electrophysiol 2011;34(9):1161–1176. DOI: 10.1111/j.1540-8159.2011.03177.x.
  6. Thaman R, Curtis S, Faganello G, et al. Cardiac outcome of pregnancy in women with a pacemaker and women with untreated atrioventricular conduction block. Europace 2011;13(6):859–863. DOI: 10.1093/europace/eur018.
  7. Keepanasseril A, Maurya DK, Suriya Y, et al. Complete atrioventricular block in pregnancy: report of seven pregnancies in a patient without pacemaker. BMJ Case Rep. 2015;2015. DOI: 10.1136/bcr-2014-208618.
  8. Ramsewak S, Persad P, Perkins S, et al. Twin pregnancy in a patient with complete heart block. A case report. Clin Exp Obstet Gynecol 1992;19(3):166–167. PMID: 1451281
  9. Avasthi K, Gupta S, Avasthi G. An unusual case of complete heart block with triplet pregnancy. Indian Heart J 2003;55:641–642. PMID: 14989517.
  10. Baghel K, Mohsin Z, Singh S, et al. Pregnancy with complete heart block. J Obstet Gynaecol India 2016;66(2):623–625. DOI: 10.1007/s13224-016-0905-z.
  11. Dalvi BV, Chandhuri A, Kulkarni HL, et al. Therapeutic guidelines for congenital complete heart block. Obstet Gynecol 1992;79:802–804. PMID: 1565369
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