Maternal complete heart block in pregnancy: Analysis of four cases and review of management

AIM: Maternal complete heart block (CHB), which manifests for the first time during pregnancy and peurperium, poses a challenge to treating physicians. We present here four cases that were diagnosed during pregnancy and peurperium, and we discuss their management issues. METHODS: A retrospective analysis of a 3-year period was carried out in a referral hospital in northern India. The course of pregnancy, disease and perinatal outcome in women with CHB diagnosed during pregnancy was studied. RESULTS: Of the four patients who presented with CHB, only one had a structural cardiac lesion (corrected transposition of great arteries). All of the women had an uneventful delivery. Two women were given prophylactic temporary pacing before labor and three women required subsequent permanent pacing. Intrauterine growth restriction (IUGR) was present in two babies and preterm labor occurred in one patient. None of the neonates had any rhythm disturbances. CONCLUSION: When a multidisciplinary approach is used, both maternal and neonatal outcomes are good. The incidence of IUGR and preterm birth may be on the increase; hence, clinical vigilance for these conditions is warranted.