Annals of medicine and surgery (2012) · 2022
Total atrioventricular block in pregnancy -Case report.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Irianti Setyorini, Tjandraprawira Kevin Dominique, Sumawan Herman, Karwiky Giky
Аннотация
INTRODUCTION AND IMPORTANCE: Bradycardia in pregnancy due to total atrioventricular block (TAVB) is a rare occurrence, often asymptomatic and may arise from a congenital disorder. Pacemaker is often required. Cases are few and management is not yet standardised.
CASE PRESENTATION: A 24-year-old G2P0A1 of 9 months gestation presented with labor pains. She had had history of bradycardia diagnosed since a year prior but had not undergone tests nor received treatments. Her heart rate was 55-60 x/minute, her cardiotocography was reassuring and electrocardiogram revealed a TAVB with ventricular escape rhythm. As she had not had a pacemaker, an urgent cardiologist consultation was arranged during which a temporary pacemaker was installed. She underwent a caesarean section with general anaesthesia after which she had an uneventful recovery.A 38-year-old G2P1A0 of 2 months of gestation presented with slow heart rhythm and a history of asthma to the outpatient clinic. She also had not undergone tests nor received medication. At presentation, her heart rate was 48 x/minute and her ECG revealed a TAVB with junctional escape rhythm. She had a pacemaker installed at 8 months of gestation and subsequently underwent an elective caesarean section at 37 weeks under regional anaesthesia. She had an uneventful recovery afterwards.
CLINICAL DISCUSSION: TAVB in pregnancy requires a concerted effort involving obstetricians, cardiologists, and intensivists. Pacemaker implantation is recommended. Whilst vaginal delivery remains first-choice, caesarean section is indicated under obstetric indications.
CONCLUSION: Screening, early recognition, risk stratification and thorough planning are required to successfully manage TAVB in pregnancy.
CASE PRESENTATION: A 24-year-old G2P0A1 of 9 months gestation presented with labor pains. She had had history of bradycardia diagnosed since a year prior but had not undergone tests nor received treatments. Her heart rate was 55-60 x/minute, her cardiotocography was reassuring and electrocardiogram revealed a TAVB with ventricular escape rhythm. As she had not had a pacemaker, an urgent cardiologist consultation was arranged during which a temporary pacemaker was installed. She underwent a caesarean section with general anaesthesia after which she had an uneventful recovery.A 38-year-old G2P1A0 of 2 months of gestation presented with slow heart rhythm and a history of asthma to the outpatient clinic. She also had not undergone tests nor received medication. At presentation, her heart rate was 48 x/minute and her ECG revealed a TAVB with junctional escape rhythm. She had a pacemaker installed at 8 months of gestation and subsequently underwent an elective caesarean section at 37 weeks under regional anaesthesia. She had an uneventful recovery afterwards.
CLINICAL DISCUSSION: TAVB in pregnancy requires a concerted effort involving obstetricians, cardiologists, and intensivists. Pacemaker implantation is recommended. Whilst vaginal delivery remains first-choice, caesarean section is indicated under obstetric indications.
CONCLUSION: Screening, early recognition, risk stratification and thorough planning are required to successfully manage TAVB in pregnancy.