A 36-year-old, G4P4 presented at 7 weeks gestation, with known Sjorgen’s Syndrome (Lupus anticoagulant and Anti Ro antibody positive) and previous deep vein thrombosis. At 20 weeks gestation both anomaly and fetal echocardiogram were undertaken and confirmed as normal. However 10 days later repeat echocardiogram confirmed congenital heart block (CHB), ventricular rate 60 bpm. There was no evidence of either fetal hydrops or heart failure. The couple was counselled regarding the potentially poor outcome.
The pregnancy continued; the fetus remained healthy albeit with CHB. Options for delivery were regularly discussed. Given both her parity and history of quick labours she was keen, if possible, to avoid surgery. Serial growth scans confirmed good growth velocity. Comprehensive evaluation of heart function and fetal circulation (CVP score) and fetal well being (Biophysical Score) was assessed and shown to be maintained throughout pregnancy and at term when she presented in early labour. Labour progressed rapidly to delivery of a female infant, in excellent condition (Apgars of 9 at 1 and 5 minutes), birth weight 3.02 kg. The newborn was transferred to SCBU and an echocardiogram re affirmed CHB with good cardiac function. She established demand feeding over the next 48 – 72 hours without compromise and was discharged home with mum within the week. She remains well and has not yet required pacing (age 1 year).
Discussion The strategy of close fetal surveillance using both biophysical profile (BPP) and cardiovascular profile (CVP) scoring during both pregnancy and early labour facilitated a spontaneous vaginal delivery at term.(1)
Huhta JC. Right ventricular function in the human fetus. J Perinat Med 2001; 29:381–9.
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