Why the study?
Complete heart block during pregnancy is rarely encountered and requires multidisciplinary management, with treatment varying from medical management to temporary or permanent pacemaker insertion.
Demonstrates that asymptomatic pregnant women with congenital complete AV block can safely undergo caesarean section under regional anesthesia without a prophylactic pacemaker.
Answers are grounded in this paper and cite their sources.
Supports considering regional anesthesia without prophylactic pacing in asymptomatic congenital AV block; hypothesis-generating and requires larger studies before practice change.
Complete heart block (CHB) during pregnancy is rarely encountered. Management requires a multidisciplinary approach involving the obstetrician, cardiologist, anesthetist, and neonatologist. Treatment varies from medical management to temporary or permanent pacemaker insertion. Complete atrioventricular block comprises complete absence of AV conduction - none of the supraventricular impulses are conducted to the ventricles. Perfusing rhythm is maintained by a junctional or ventricular escape rhythm. Typically, the patient will have severe bradycardia with independent atrial and ventricular rates. The incidence is 1 in 15,000 to 20,000 live births. We successfully managed caesarean section in a pregnancy with complete atrioventricular block under spinal and epidural anesthesia without a pacemaker. Asymptomatic pregnant women with congenital complete atrioventricular block can tolerate caesarean section under spinal and epidural anesthesia without a pacemaker.
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Mishra et al. (2023) studied this question.
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