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Unexpected heart block in the delivery room: the utility of ECG monitoring
  1. Birju A Shah,
  2. Edgardo Szyld,
  3. Anne G Wlodaver
  1. Neonatal-Perinatal Medicine, Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
  1. Correspondence to Dr Birju A Shah, Neonatal-Perinatal Medicine, Pediatrics, University of Oklahoma Health Sciences, Oklahoma City, OK 73104, USA; birju-shah{at}

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A woman, who had not received adequate prenatal care, arrived in labour at 38 weeks’ gestation and rapidly delivered a 3 kg baby boy via repeat caesarean section. At the time of arrival, the head was engaged in the pelvis, and a vaginal hand was used during the delivery. Fetal heart rate patterns were unknown prior to delivery, due to scant fetal monitoring. She reported a history of depression and tobacco use during pregnancy.

Soon after birth, at about 3 minutes, the advanced neonatal resuscitation team was called. The infant was floppy and without heart beats detectable by pulse oximetry, despite initial standard neonatal resuscitation efforts. He was receiving …

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  • Contributors BAS drafted and edited the letter. ES and AGW revised and edited the letter.

  • Competing interests None declared.

  • Patient consent Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; internally peer reviewed.