Persistent Fetal SVT in a COVID-19 Positive Pregnancy

Background. Rapid introduction and spread of SARS-CoV-2 have posed unique challenges in understanding the disease, role in vertical transmission, and in developing management. We present a case of a patient with COVID-19 infection and fetus with new-onset fetal SVT. Case. A 26-year-old gravida 4 para 2012 with third trimester COVID-19 infection was diagnosed with new onset fetal SVT. Successful cardioversion was achieved with flecainide. The patient was followed outpatient until induction of labor at 39 and 3/7 weeks of gestational age resulting in an uncomplicated vaginal delivery. Postpartum course was uncomplicated. Conclusion. Fetal SVT is a potential complication of maternal COVID-19 infection. The use of transplacental therapy with flecainide is an appropriate alternative to digoxin in these cases.

Maternal monitoring and safety considerations during antiarrhythmic treatment for fetal supraventricular tachycardia

Fetal tachycardia is a rare complication during pregnancy. After exclusion of maternal and fetal conditions that can result in a secondary fetal tachycardia, supraventricular tachycardia is the most common cause of a primary sustained fetal tachyarrhythmia. In cases of sustained fetal supraventricular tachycardia, maternal administration of digoxin, flecainide, sotalol, and more rarely amiodarone, is considered. As these medications have the potential to cause significant adverse effects, we sought to examine maternal safety during transplacental treatment of fetal supraventricular tachycardia. In this narrative review we summarize the literature addressing pharmacologic properties, monitoring, and adverse reactions associated with medications most commonly prescribed for transplacental therapy of fetal supraventricular tachycardia. We also describe maternal monitoring practices and adverse events currently reported in the literature. In light of our findings, we provide clinicians with a suggested maternal monitoring protocol aimed at optimizing safety.

Response of fetal tachycardia to transplacental procainamide therapy

We describe two fetuses presenting with hydrops and tachycardia who were treated by prolonged dosage with procainamide. Initial therapy with digoxin in both had been unsuccessful in controlling the rapid heart rate. The first child was delivered after five weeks of transplacental therapy, and demonstrated Wolff-Parkinson-White syndrome on the second day which was controlled with flecainide. The second fetus required three and a half weeks of intrauterine treatment. Wolff-Parkinson-White syndrome became manifest four days after premature labor at 33 weeks gestation. No tachycardia occurred postnatally and the infant has been well during follow-up. The implications of treatment are discussed.