Abstract
BackgroundComplete heart block in pregnancy has serious implications particularly during the period of delivery. This is more so if the delivery is an operative one as the presence of heart block may produce haemodynamic instability in the intra operative period. We report a unique case of a pregnant mother with complete heart block undergoing hysterostomy, complicated by placenta accreta and intrauterine death.Case presentationA 37 year old Malaysian Chinese parturient was admitted at 25 weeks gestation following a scan which suggested intrauterine death and placenta accreta. She was diagnosed to have congenital complete heart block after her first delivery eight years previously but a pacemaker was never inserted. These medical conditions make her extremely likely to experience massive bleeding and haemodynamic instability. Among the measures taken to optimise her pre-operatively were the insertion of a temporary intravenous pacemaker and embolization of the uterine arteries to minimize peri-operative blood loss. She successfully underwent surgery under general anesthesia, which was relatively uneventful and was discharged well on the fourth post-operative day.ConclusionCongenital heart block in pregnancies in the presence of potential massive bleeding is best managed by a team, with meticulous pre-operative optimization. Suggested strategies would include insertion of a temporary pacemaker and embolization of the uterine arteries to reduce the risk of the patient getting into life threatening situations.
Highlights
Complete heart block in pregnancy has serious implications during the period of delivery
Congenital heart block in pregnancies in the presence of potential massive bleeding is best managed by a team, with meticulous pre-operative optimization
Complete heart block, known as third degree atrioventricular (AV) or third degree heart block is a disorder of the cardiac conduction system with complete absence of AV conduction
Summary
Congenital CHB in pregnancies in the presence of potential massive bleeding is best managed as a team, with meticulous pre-operative optimization. Suggested strategies would include insertion of a temporary pacemaker and embolization of the uterine arteries in situations where excessive bleeding is likely to contribute to a life threatening situation. Consent Written informed consent was obtained from the patient for publication of this case report. A copy of the written consent is available for review by the Editor of this journal. 2. Yu P, Ou H, Tsang L, Kung F, Hsu T, Cheng Y: Prophylactic intraoperative uterine artery embolization to control hemorrhage in abnormal placentation during late gestation. 3. Adekanye O, Srinivas K, Collis RE: Bradyarrhythmias in pregnancy: A case report and review of management.
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