scholarly journals Fetal Tachycardia in the Delivery Room: Fetal Distress, Supraventricular Tachycardia, or Both?

2020 ◽  
Vol 10 (04) ◽  
pp. e380-e385
Author(s):  
Satvinder Singh Bhatia ◽  
Wendy H. Burgess ◽  
Jonathan R. Skinner
Keyword(s):  
Heart Rate ◽  
Differential Diagnosis ◽  
Supraventricular Tachycardia ◽  
Fetal Distress ◽  
Emergency Cesarean ◽  
Rapid Heart Rate ◽  
Life Threatening ◽  
Antenatal Detection ◽  
Fetal Arrhythmia ◽  
Fetal Tachycardia

Abstract Background Supraventricular tachycardia (SVT) is seldom considered a cause for fetal tachycardia; commoner etiologies including maternal fever and fetal distress are usually envisaged. Fetal arrhythmia can be missed as a diagnosis, potentially leading to suboptimal management. Cases Three cases are described where detection of fetal tachycardia >200 beats per minute (bpm) at 36, 40, and 38 weeks gestation resulted in emergency cesarean section for presumed fetal distress. Retrospective review of the cardiotocograph in two cases revealed baseline heart rates 120 to 160 bpm, with loss of trace associated with auscultated rates over 200 bpm. The diagnosis of SVT was not initially considered and made later when the infants required cardioversion at the age of 3 weeks, 2 days, and 8 days, respectively. The 36-week infant required noninvasive ventilation for prematurity. Conclusion SVT should be actively considered in the differential diagnosis of fetal tachycardia. Unrecognized fetal SVT may result in avoidable caesarean for suspected fetal distress, with potential prematurity-related problems. The cardiotocograph can be helpful if showing contact loss associated with rapid heart rate auscultation. The antenatal detection of fetal SVT is important as it can allow anticipation and prevention of neonatal SVT, which is potentially life-threatening if not detected and treated promptly.

scholarly journals Drug Resistant Fetal Arrhythmia in Obstetric Cholestasis

2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
Nahide Altug ◽  
Ayse Kirbas ◽  
Korkut Daglar ◽  
Ebru Biberoglu ◽  
Dilek Uygur ◽  
...  
Keyword(s):  
Liver Disease ◽  
Bile Acid ◽  
Supraventricular Tachycardia ◽  
Preterm Labor ◽  
Fetal Distress ◽  
Intrauterine Death ◽  
Drug Resistant ◽  
Fetal Arrhythmia ◽  
Antiarrhythmic Treatment

Obstetric cholestasis (OC) is a pregnancy specific liver disease characterized by increased levels of bile acid (BA) and pruritus. Raised maternal BA levels could be associated with intrauterine death, fetal distress, and preterm labor and also alter the rate and rhythm of cardiomyocyte contraction and may cause fetal arrhythmic events. We report a case of drug resistant fetal supraventricular tachycardia and concomitant OC.Conclusion.If there are maternal OC and concomitant fetal arrhythmia, possibility of the resistance to antiarrhythmic treatment should be kept in mind.

scholarly journals Supraventricular Tachycardia in Pregnancy

2021 ◽  
Vol 8 (3) ◽  
pp. 88-90
Author(s):  
Gauri Prabhu ◽  
Shubha SR ◽  
M.B. Bellad ◽  
Shridevi Metugud
Keyword(s):  
Heart Rate ◽  
Supraventricular Tachycardia ◽  
Treatment Options ◽  
Tertiary Care ◽  
Electrical Cardioversion ◽  
Reproductive Age ◽  
Paroxysmal Supraventricular Tachycardia ◽  
Tertiary Care Centre ◽  
Intravenous Amiodarone ◽  
Life Threatening

The commonest arrhythmia in women of reproductive age, is paroxysmal supraventricular tachycardia (SVT). We present a rare case of SVT who presented for the first time during pregnancy, who failed to respond to Electrical cardioversion(ECV), but reverted back to sinus rhythm by secondline pharmacotherapy. PROCEDURE: A 22 year old primigravidapresented at 37weeks in labour with complaints of breathlessness and severe palpitations when she was diagnosed to have supraventricular tachycardia(SVT) on ECG and was referred to a tertiary care centre for further management.Pharmacological cardioversion was attempted with intravenous diltiazem, but in vain. Decision was taken for electrical cardioversion with synchronized DC shocks of 50 joules and 100 joules successively, but was not successful too. As a last resort, bolus of intravenous Amiodarone 150 mg was given over 10 minutes followed by infusion at the rate of 24 mg per hour(2ml/hr), which finally brought down the heart rate to 98bpm. In view of non-reassuring fetal heart rate observed on CTG, patient was taken up for an emergency caesarean section under epidural anaesthesia with grave risk consent and shifted to ICCU post-operatively. RESULT: Patient delivered a male baby of birth weight 2.35kg. Patient tolerated the surgery well and did not experience any episodes of PSVT throughout the intra-operative period. Postoperatively patient was managed in consultation with cardiologist. Amiodarone infusion was continued for 24 hours at 24mg/ hour. Post-operative period was uneventful, patient was started on oral anti arrhythmic medications and discharged on the same. CONCLUSION : Accurate diagnosis, regular follow up and multidisciplinary approach during acute episode and during delivery can prevent life threatening risks that might be posed to the mother and fetus in a case of PSVT. Treatment options include nonpharmacological therapy, followed by adenosine and other drugs if required, and lastly electrical cardioversion

scholarly journals Early-Onset Neonatal listeriosis –A Case Report

2020 ◽  
pp. 1-3
Author(s):  
Asma H ◽  
◽  
Ngeow Yun-Fong ◽  
Lim Chin-Theam ◽  
◽  
...  
Keyword(s):  
Early Onset ◽  
Fetal Heart ◽  
Ventilatory Support ◽  
Fetal Distress ◽  
Complete Recovery ◽  
Laboratory Diagnosis ◽  
Preterm Baby ◽  
External Monitoring ◽  
Emergency Cesarean ◽  
Fetal Tachycardia

A 25-year-old primigravida in her 30 weeks of gestation presented with fever and some flu-like symptoms. There was minimal vaginal discharge. Keeping in view the possibility of chorioamnionitis a prompt intravenous infusion of antibiotics was instituted with continuous external monitoring of fetal heart rate. An emergency cesarean section was performed 3 hours later for persistent fetal tachycardia suggestive of fetal distress. A preterm baby girl was born with evidence of respiratory distress requiring ventilatory support. Listeria monocytogenes was isolated from newborn’s blood culture, tracheal secretions and the placental swab, confirming neonatal listeriosis. Cerebro-spinal fluid examination did not reveal evidence of meningitis. Prompt laboratory diagnosis and aggressive antibiotic treatment led to complete recovery of the infant from septicemia. This represents the first reported case of early-onset neonatal listeriosis in Malaysia

scholarly journals Cesarean Audit for fetal distress- A indispensable tool to reduce Obstetrician Distress

2021 ◽  
Vol 5 (1) ◽  
pp. 01-04
Author(s):  
Anuradha Singh
Keyword(s):  
Heart Rate ◽  
Cesarean Section ◽  
Fetal Heart Rate ◽  
Fetal Heart ◽  
Fetal Distress ◽  
Fetal Outcome ◽  
Emergency Cesarean ◽  
Audit Period ◽  
Nicu Admission ◽  
Operative Findings

Background and Objectives: Overuse of cesarean section and its implications are of growing concern. Suspected fetal distress has been the commonest indication for cesarean in last few decades heart rate changes shown by fetus without being adversely affected and CTG has been criticized to create unnecessary higher rate of operative deliveries. There is need to know which fetal heart rate abnormality is important and leading to two adverse neonatal outcome to decrease unnecessary operative deliveries. Therefore Caesarean Audit was planned. Material and methods: A total of hundred women were included who underwent emergency cesarean section for suspected fetal distress in labour or without labour detected by cardiotocography or intermittent auscultation were included for analysis. Details were noted in pre designated proforma. Results: During the audit period, total number of caesarean done due to fetal distress analysed during the period were 100.The most common fetal heart rate abnormality was nonspecific in form of single or transient deceleration seen in 63% of cases where records were also incomplete, it was followed by persistent deceleration on cardiotocography which was present in 16% of the cases. In 57 women who were primigravida 14 (24%) patients had nonspecific fetal heart rate patterns and intra operative findings were normal in this group. These were avoidable cesareans. Various Intraoperative findings, observed ,maximum no. of cases had meconium stained liquor seen in 63% of the cases followed by abruption in 9 cases followed by other findings like loop of cord around the neck of foetus, thin scar or scar dehiscence . Maternal resuscitation was carried out only in 53% of cases. Detection delivery interval of less than 30 minutes was present in 4% of cases. In fetal outcomes 16% of babies diagnosed with fetal distress, had poor outcome where Apgar score < 7 and 12 babies had asphyxia related NICU admission. 82% of babies had absolutely normal fetal outcome among which majority (78%) did not require any form resuscitation. which were thus avoidable cases. Conclusions: Correct Knowledge about Standardized fetal heart rate interpretations on CTG and there standardized management protocols like Maternal resuscitative measures ,follow up to ensure fast detection delivery interval should be practiced strictly in all cases of non reassuring Fetal Heart rate patterns. There should be consistent efforts in reducing the rate of cesarean sections particularly primary cesarean deliveries and in order to understand the degree to which cesarean delivery is preventable it is important to know no why cesareans are being performed. Therefore caesarean audit is need of the hour

A Case of Emergency Cesarean Section on Client with Pseudopregnancy

2020 ◽  
pp. 1-6
Keyword(s):  
Heart Rate ◽  
Cesarean Section ◽  
Fetal Heart Rate ◽  
Medical Service ◽  
Fetal Heart ◽  
Placenta Previa ◽  
Urban Hospital ◽  
Emergency Cesarean Section ◽  
Emergency Cesarean ◽  
Rural Health Center

Pseudopregnancy detection is significant while as the false pregnancy may show all symptoms. It is important to differentiate it. This is a case report of a pseudopregnancy which led to an emergency cesarean section. A 28-year-old woman who claimed to 7-month pregnancy was brought to the rural health center by husband families complaining of vaginal bleeding. The woman refers to an urban hospital by Emergency Medical Service with the diagnosis of placenta previa. In the hospital, she underwent an emergency cesarean section due to a severe deceleration of fetal heart rate, prior to assessing by sonography. No fetus or signs of uterine or abdominal pregnancy were found. Wrong auscultation of the mother's heart rate instead of fetal heart rate seems to be the main error. It is required to pay more attention to the methods of differentiation of fetal heart rate from the mother's heart rate. This report enlightens false pregnancy and early differentiation.

A Serological Storm

1970 ◽  
Vol 9 (2) ◽  
Author(s):  
Bertha Wong MD ◽  
Maria Bagovich MD ◽  
Ivan Blasutig PhD ◽  
Simon Carette MD MPhil
Keyword(s):  
Differential Diagnosis ◽  
Hepatitis C Virus ◽  
Immune System ◽  
Hepatitis C ◽  
Hcv Infection ◽  
Clinical Context ◽  
Autoantibody Profile ◽  
Life Threatening ◽  
Clinically Significant ◽  
Sensory Polyneuropathy

This article describes a patient presenting with a sensory polyneuropathy and multiple autoantibodies, leading to the diagnosis of hepatitis C virus (HCV) infection. His widely positive autoantibody profile in the absence of clinically significant rheumatic disease illustrates the importance of interpreting autoimmune serology in the appropriate clinical context and the concept of HCV being a non-specific activator of the immune system. In addition, it highlights the importance of considering untreated HCV infection in the differential diagnosis of rheumatic complaints, particularly if the workup reveals multiple autoantibodies, as HCV is a potentially severe and life-threatening disease, which can be appropriately managed with effective antiviral therapy.

scholarly journals The Successful Use of Nitroglycerin for Uterine Hyperstimulation with Fetal Heart Rate Abnormality Caused by a Controlled-Release Dinoprostone Vaginal Delivery System (PROPESS): A Case Report

Medicina ◽  
2021 ◽  
Vol 57 (5) ◽  
pp. 478
Author(s):  
Sho Takakura ◽  
Hiroaki Tanaka ◽  
Naosuke Enomoto ◽  
Shintaro Maki ◽  
Tomoaki Ikeda
Keyword(s):  
Heart Rate ◽  
Controlled Release ◽  
Vaginal Delivery ◽  
Delivery System ◽  
Fetal Heart Rate ◽  
Fetal Heart ◽  
Cervical Ripening ◽  
Emergency Cesarean ◽  
Uterine Hyperstimulation ◽  
Uterine Relaxation

The PROPESS, a controlled-release dinoprostone vaginal delivery system, is a pharmacological cervical ripening intervention and promotes cervical change causing uterine contraction. During insertion of the PROPESS, uterine hyperstimulation could occur and result in fetal heart rate (FHR) abnormality. We report a case of uterine hyperstimulation accompanied with FHR abnormality caused by the PROPESS in a pregnant woman. Postural change, oxygenation, fluid infusion, and the immediate PROPESS removal were ineffective to address the adverse event, so we administered nitroglycerin for acute uterine relaxation. The nitroglycerin resulted in uterine relaxation, and the FHR abnormality was resolved immediately, thereby preventing an emergency cesarean section. Therefore, nitroglycerin could be considered an effective option for uterine hyperstimulation accompanied with FHR abnormality caused by the PROPESS.

scholarly journals Severe Acute Respiratory Syndrome Coronavirus 2 Placental Infection and Inflammation Leading to Fetal Distress and Neonatal Multi-Organ Failure in an Asymptomatic Woman

2020 ◽  
Author(s):  
Sam Schoenmakers ◽  
Pauline Snijder ◽  
Robert M Verdijk ◽  
Thijs Kuiken ◽  
Sylvia S M Kamphuis ◽  
...  
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Vertical Transmission ◽  
Neonatal Intensive Care ◽  
Quantitative Polymerase Chain Reaction ◽  
Antigen Expression ◽  
Fetal Distress ◽  
Adverse Outcomes ◽  
Placental Infection ◽  
Emergency Cesarean ◽  
Increased Risk

Abstract Background In general, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy is not considered to be an increased risk for severe maternal outcomes but has been associated with an increased risk for fetal distress. Maternal-fetal transmission of SARS-CoV-2 was initially deemed uncertain; however, recently a few cases of vertical transmission have been reported. The intrauterine mechanisms, besides direct vertical transmission, leading to the perinatal adverse outcomes are not well understood. Methods Multiple maternal, placental, and neonatal swabs were collected for the detection of SARS-CoV-2 using real-time quantitative polymerase chain reaction (RT-qPCR). Serology of immunoglobulins against SARS-CoV-2 was tested in maternal, umbilical cord, and neonatal blood. Placental examination included immunohistochemical investigation against SARS-CoV-2 antigen expression, with SARS-CoV-2 ribonucleic acid (RNA) in situ hybridization and transmission electron microscopy. Results RT-qPCRs of the oropharynx, maternal blood, vagina, placenta, and urine were all positive over a period of 6 days, while breast milk, feces, and all neonatal samples tested negative. Placental findings showed the presence of SARS-CoV-2 particles with generalized inflammation characterized by histiocytic intervillositis with diffuse perivillous fibrin depositions with damage to the syncytiotrophoblasts. Conclusions Placental infection by SARS-CoV-2 leads to fibrin depositions hampering fetal-maternal gas exchange with resulting fetal distress necessitating a premature emergency cesarean section. Postpartum, the neonate showed a fetal or pediatric inflammatory multisystem-like syndrome with coronary artery ectasia temporarily associated with SARS-CoV-2 for which admittance and care on the neonatal intensive care unit (NICU) were required, despite being negative for SARS-CoV-2. This highlights the need for awareness of adverse fetal and neonatal outcomes during the current coronavirus disease 2019 pandemic, especially considering that the majority of pregnant women appear asymptomatic.

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