Aggressive direct treatment of a fetus with supraventricular tachycardia and hydrops fetalis.

We report a case, in which direct fetal therapy by amiodarone injected into the umbilical vein during the last trimester of pregnancy was used for the treatment of fetal supraventricular tachyarrhythmia in the presence of severe hydrops fetalis. Eight injections were needed due to the recurrence of supraventricular tachycardia 1-9 days after the initial normalization of fetal tachycardia after each puncture. A severe fetal hydrops was maintained despite the achievement of sinus rhythm, and thus two ascites draining procedures were performed during the last 3 days before delivery to expand the fetal lungs. A normorhythmic hydropic baby was born by Cesarean section at 34 weeks + 6 days. Only mild respiratory difficulties occurred after birth. Her electrocardiogram suggests a Wolff-Parkinson-White syndrome but the overall recovery has been uneventful.