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Successful pregnancy outcome with cardiac pacemaker after complete heart block
International Journal of Gynecology & Obstetrics 68 Ž2000. 145᎐146
Brief communication
Successful pregnancy outcome with cardiac pacemaker after complete heart block J.B. SharmaU , M. Malhotra, P. Pundir Department of Obstetrics and Gynecology, Maulana Azad Medical College and Affiliated Lok Nayak Hospital, New Delhi, India Received 17 August 1999; received in revised form 28 October 1999; accepted 4 November 1999
Keywords: Complete heart block; Cardiac pacemaker; Pregnancy outcome
Complete heart block is a rare and serious complication in pregnancy with most of the publications being isolated case reports w1x. A 24-year-old second gravida with previous uneventful normal vaginal delivery three years back presented in the obstetrics department with a 39-week pregnancy with history of decreased fetal movements and feeling unwell for the last three days. There was no history of labor pains, leaking or bleeding per vaginum. There was no history of heart disease in the past. There was no history of palpitations, cough, fever, edema, dysnea, orthopnea, paroxysmal nocturnal dyspnea or chest pain. On examination she looked unwell. Mild pallor was present. There was no cyanosis or edema. Pulse rate was 40 b.p.m. and regular. Blood pressure was 110r60 mmHg. Jugular venous pressure was not raised. The examination of cardiorespiraU
Corresponding author. Azad Apartments, Sri Aurobindo Marg, New Delhi, India. Fax: q91-11-6866961. E-mail address: [email protected] ŽJ.B. Sharma.
tory system revealed no abnormality. On abdominal examination there was a singleton fetus presenting as vertex. Uterine height corresponded to 32 weeks gestation with oligohydramnios. There were no uterine contractions. Fetal heart was 140 b.p.m. Hemoglobin was 9 grdl, urine routine and microscopy was normal. Electrocardiogram showed complete heart block. Ultrasound confirmed the diagnosis of oligohydramnios with intrauterine retardation with normal biophysical profile and an estimated fetal weight of 2 kg. A temporary cardiac pacemaker was implanted and a heart rate of 90 b.p.m. was achieved. The labor was induced with intracervical prostaglandin-E 2 gel. The labor progressed well and she delivered within 10 h of induction. A female baby of weight 1960 g with Apgar of 7 at 1 min and 10 at 5 min was born in good condition. She was given parenteral antibiotics and subcutaneous heparin. Her puerperium was uneventful and she was discharged on heparin in good condition for a follow-up in the cardiology department for a per-
0020-7292r00r$20.00 䊚 2000 International Federation of Gynecology and Obstetrics. PII: S 0 0 2 0 - 7 2 9 2 Ž 9 9 . 0 0 2 0 6 - 4
146
J.B. Sharma et al. r International Journal of Gynecology & Obstetrics 68 (2000) 145᎐146
manent pacemaker which has now been implanted and is working well. Complete heart block is a serious condition and has to be managed energetically. It can cause Adams Stokes attacks. Effect on pregnancy may be IUGR and or polycythemia w2x. Management should be by cardiac pacemaker which should be implanted before pregnancy if diagnosed or whenever diagnosed in pregnancy to maintain adequate cardiac functioning w3x. Although cesarean section has been recommended by some authors, vaginal delivery can be allowed as in the present case w4x.
References w1x Dalvi BV, Chaudhuri A, Kulkarni HL, Kale PA. Therapeutic guidelines for congenital complete heart block presenting in pregnancy. Obstet Gynecol 1992;79Ž5.: 802᎐804. w2x Plesse R, During R. A case of intrauterine fetal retardation with polycythemia in a patient with a pacemaker. Zentralbl Gynekol 1984;106Ž23.:1547᎐1550. w3x Jaffe R, Gruber A, Fejgin M, Altaras M, Ben-Aderet N. Pregnancy with an artificial pacemaker. Obstet Gynecol Surv 1987;42Ž3.:137᎐139. w4x Huang H, Lin Q, Zhang L. Clinical observation of cardiac pacemaker in pregnant women. Chung Hua Fu Chan Ko Tsa Chin 1997;32Ž6.:345᎐346.
Brief communication
Successful pregnancy outcome with cardiac pacemaker after complete heart block J.B. SharmaU , M. Malhotra, P. Pundir Department of Obstetrics and Gynecology, Maulana Azad Medical College and Affiliated Lok Nayak Hospital, New Delhi, India Received 17 August 1999; received in revised form 28 October 1999; accepted 4 November 1999
Keywords: Complete heart block; Cardiac pacemaker; Pregnancy outcome
Complete heart block is a rare and serious complication in pregnancy with most of the publications being isolated case reports w1x. A 24-year-old second gravida with previous uneventful normal vaginal delivery three years back presented in the obstetrics department with a 39-week pregnancy with history of decreased fetal movements and feeling unwell for the last three days. There was no history of labor pains, leaking or bleeding per vaginum. There was no history of heart disease in the past. There was no history of palpitations, cough, fever, edema, dysnea, orthopnea, paroxysmal nocturnal dyspnea or chest pain. On examination she looked unwell. Mild pallor was present. There was no cyanosis or edema. Pulse rate was 40 b.p.m. and regular. Blood pressure was 110r60 mmHg. Jugular venous pressure was not raised. The examination of cardiorespiraU
Corresponding author. Azad Apartments, Sri Aurobindo Marg, New Delhi, India. Fax: q91-11-6866961. E-mail address: [email protected] ŽJ.B. Sharma.
tory system revealed no abnormality. On abdominal examination there was a singleton fetus presenting as vertex. Uterine height corresponded to 32 weeks gestation with oligohydramnios. There were no uterine contractions. Fetal heart was 140 b.p.m. Hemoglobin was 9 grdl, urine routine and microscopy was normal. Electrocardiogram showed complete heart block. Ultrasound confirmed the diagnosis of oligohydramnios with intrauterine retardation with normal biophysical profile and an estimated fetal weight of 2 kg. A temporary cardiac pacemaker was implanted and a heart rate of 90 b.p.m. was achieved. The labor was induced with intracervical prostaglandin-E 2 gel. The labor progressed well and she delivered within 10 h of induction. A female baby of weight 1960 g with Apgar of 7 at 1 min and 10 at 5 min was born in good condition. She was given parenteral antibiotics and subcutaneous heparin. Her puerperium was uneventful and she was discharged on heparin in good condition for a follow-up in the cardiology department for a per-
0020-7292r00r$20.00 䊚 2000 International Federation of Gynecology and Obstetrics. PII: S 0 0 2 0 - 7 2 9 2 Ž 9 9 . 0 0 2 0 6 - 4
146
J.B. Sharma et al. r International Journal of Gynecology & Obstetrics 68 (2000) 145᎐146
manent pacemaker which has now been implanted and is working well. Complete heart block is a serious condition and has to be managed energetically. It can cause Adams Stokes attacks. Effect on pregnancy may be IUGR and or polycythemia w2x. Management should be by cardiac pacemaker which should be implanted before pregnancy if diagnosed or whenever diagnosed in pregnancy to maintain adequate cardiac functioning w3x. Although cesarean section has been recommended by some authors, vaginal delivery can be allowed as in the present case w4x.
References w1x Dalvi BV, Chaudhuri A, Kulkarni HL, Kale PA. Therapeutic guidelines for congenital complete heart block presenting in pregnancy. Obstet Gynecol 1992;79Ž5.: 802᎐804. w2x Plesse R, During R. A case of intrauterine fetal retardation with polycythemia in a patient with a pacemaker. Zentralbl Gynekol 1984;106Ž23.:1547᎐1550. w3x Jaffe R, Gruber A, Fejgin M, Altaras M, Ben-Aderet N. Pregnancy with an artificial pacemaker. Obstet Gynecol Surv 1987;42Ž3.:137᎐139. w4x Huang H, Lin Q, Zhang L. Clinical observation of cardiac pacemaker in pregnant women. Chung Hua Fu Chan Ko Tsa Chin 1997;32Ž6.:345᎐346.