Key result
Expectant management with steroids and β-mimetics results in healthy delivery despite complete fetal heart block.
Why the study?
Can expectant management with steroids and β-mimetics lead to a favorable outcome in a pregnancy with complete fetal heart block and severe bradycardia?
Case Report (n=1)
Can expectant management with steroids and β-mimetics lead to a favorable outcome in a pregnancy with complete fetal heart block and severe bradycardia?
Expectant management with standard fetal testing until fetal lung maturity can be successful in pregnancies complicated by congenital heart block and severe fetal bradycardia with a structurally normal heart.
May support expectant management in select fetal heart block cases; hypothesis-generating and requires prospective validation before practice change.
In Brief BACKGROUND Pregnancies complicated by congenital heart block usually have a poor prognosis when there is severe fetal bradycardia. CASE We present a pregnancy with fetal heart rate of 40 beats per minute. She previously delivered a child with third-degree heart block by cesarean at 28 weeks. This pregnancy was complicated by a high ribonucleoprotein antibody anti-Ro/SSA titer and fetal bradycardia. The patient was treated with steroids and β-mimetics. The fetus continued to grow normally with reassuring biophysical profiles. After fetal lung maturity documentation at 34 weeks, she delivered by repeat cesarean a healthy 2349-g infant who required a permanent pacemaker. CONCLUSION Reassuring antepartum testing and normal growth in pregnant women with anti-Ro/SSA antibodies and congenital heart block may allow expectant management until fetal maturity. Congenital heart block and severe fetal bradycardia, with a structurally normal heart, is managed successfully with standard fetal testing until documentation of fetal lung maturity.
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Minassian et al. (2002) conducted a case report in Pregnancy with complete fetal heart block and severe bradycardia (n=1). Steroids and β-mimetics (expectant management) was evaluated on Delivery of a healthy infant. Expectant management with steroids and β-mimetics in a pregnancy with complete fetal heart block and severe bradycardia resulted in the delivery of a healthy infant at 34 weeks.
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