Morphine-induced supraventricular tachycardia in near-term fetus

Vincenzo Zanardo,Alphonse Simbi,Gianluca Straface,Riccardo Carta,Matteo Parotto,Pietro Guerrini,Lorenzo Severino

doi:10.1186/s13052-018-0570-1

Vincenzo Zanardo, Alphonse Simbi + Show 5 more

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https://doi.org/10.1186/s13052-018-0570-1

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BackgroundFetal supraventricular tachycardia (SVT), characterized by fetal heart rate between 220 and 260 bpm, is a rare but most commonly encountered fetal cardiac arrhythmia in pregnancy that may be associated with adverse perinatal outcome.Case presentationWe describe a 36/6 week near term fetus who presented morphine-induced SVT after maternal treatment of a renal colic. Following emergency cesarean section, the neonate had resolution of symptoms.ConclusionsThe pathophysiology of morphine-related SVT, previously documented in experimental animal models, and for the first time reported in the human fetus, is presented.

Highlights

Fetal supraventricular tachycardia (SVT), characterized by fetal heart rate (HR) between 220 and 260 beats per minute is a rare but most commonly encountered fetal cardiac arrhythmia in pregnancy that may be associated with adverse perinatal outcome [3, 4]
Excessive caffeine, smoking, illicit drugs exposure, hyperthyroidism in pregnant women and cardiac malformations or extracardiac malformations in fetuses, respectively may contribute to frequent fetal premature atrial contractions which may progress to unrelenting tachyarrhythmia [6]
For the first time, a case of morphine-induced SVT in a near-term fetus diagnosed by using M-mode and pulsed Doppler ultrasonography, in close temporal relationship with the mother treatment with opioid for a lasting painful renal colic

Summary

Background

First recognized in 1930 by Hyman et al, is a condition occurring in approximately 0.4–0.6% of all pregnancies [1, 2]. She had no past surgical or medical history, but she was presenting acute pelvic pain, related to renal colic Her vital signs were as follows: blood pressure 115/68 mmHg, HR 73 bpm, respiratory rate 17 breaths per minute, and temperature 36.7 °C. Mean blood pressure 38 mmHg. Tachycardia was noticed at birth 240 bpm, and the HR progressively decreased starting at 60 min after birth and reached normal levels during the following 3 h. His weight increased normally and there was no evidence of cardiac rhythm disturbance up to the 1-year follow-up as outpatient in the pediatric cardiology department

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