Asymptomatic complete heart block in labor: A case report of none response to atropine therapy
Introduction: A complete heart block is a cardiac electrical conduction disorder with a very rare occurrence in pregnancy, which may be asymptomatic. There are no specific guidelines for the management of asymptomatic complete heart block in labor, vaginal delivery, and cesarean with only a few reports of cesarean management of patients with complete heart block.
Case report: A 30-year-old woman, Gravida 4, abortion 3, gestational age of 41 weeks without any specific problems, was referred to our maternity hospital. The pulse rate and blood pressure were 68 and 60/110, respectively. Labor was induced with oxytocin and, after three hours, was discontinued due to late decelerations of fetal heart rate. Electrocardiography confirmed a maternal pulse rate of 42. Cardiac consultation led to the diagnosis of a complete heart block. Due to the frequent late decelerations of fetal heart rate and no response to atropine therapy, the patient was a candidate for a cesarean. Before cesarean, the pacemaker was installed. Cesarean was performed with general anesthesia, and the infant was delivered in good condition. In Postpartum, the pacemaker was removed (PR = 55, BP = 125/80), and the mother was discharged the next day. Due to the lack of specific guidelines, fetal indication for an emergency cesarean, mother poor obstetrics history, and none response to atropine therapy, we chose to incorporate pacemakers and remove it after cesarean safely.
Conclusion: Vital signs assessment during pregnancy and childbirth is recommended to detect cases of complete heart block and provide optimal care.
2. Mandal S, Mandal D, Sarkar A, Biswas J, Panja M. Complete heart block and pregnancy outcome: an analysis from eastern India. SOJ Gynaecol Obstet Womens Health. 2015;1(1):5.
3. Hidaka N, Chiba Y, Fukushima K, Wake N. Pregnant women with complete atrioventricular block: perinatal risks and review of management. Pacing and clinical electrophysiology. 2011 Sep;34(9):1161-76.
4. Hidaka N, Chiba Y, Kurita T, Satoh S, Nakano H. Is intrapartum temporary pacing required for women with complete atrioventricular block? An analysis of seven cases. BJOG: An International Journal of Obstetrics & Gynaecology. 2006 May;113(5):605-7.
5. Keepanasseril A, Maurya DK, Selvaraj R. Complete atrioventricular block in pregnancy: report of seven pregnancies in a patient without pacemaker. Case Reports. 2015 Mar 7;2015:bcr2014208618.
6. Kharde VV, Patil VV, Dhulkhed VK, Divekar DS. A parturient with complete heart block for caesarean section. Journal of Anaesthesiology Clinical Pharmacology. 2010 Jul 1;26(3):401-2.
7. Kivrak T, Kivrak V, Kivrak YY, Karaca I. Presenting of pregnant woman with atrioventricular block. SM J Case Rep. 2017;3(5):1058.
8. Kumar AU, Sripriya R, Parthasarathy S, Ganesh BA, Ravishankar M. Congenital complete heart block and spinal anaesthesia for caesarean section. Indian journal of anaesthesia. 2012 Jan;56(1):72.
9. Modi PM, Butala B, Shah VR. Anaesthetic management of an unusual case of complete heart block for LSCS. Indian J Anaesth. 2006 Feb;50(1):43-4.
10. Mohapatra V, Panda A, Behera S, Behera JC. Complete heart block in pregnancy: A report of emergency caesarean section in a parturient without pacemaker. Journal of clinical and diagnostic research: JCDR. 2016 Oct;10(10):QD01.
11. Soni S, Hazarika A. Cesarean delivery in congenital heart block and need of temporary pacing: A case report. Saudi journal of anaesthesia. 2019 Jul;13(3):274.
12. Suri V, Keepanasseril A, Aggarwal N, Vijayvergiya R, Chopra S, Rohilla M. Maternal complete heart block in pregnancy: analysis of four cases and review of management. Journal of Obstetrics and Gynaecology Research. 2009 Jun;35(3):434-7.
13. Thaman R, Curtis S, Faganello G, Szantho GV, Turner MS, Trinder J, Sellers S, Stuart GA. Cardiac outcome of pregnancy in women with a pacemaker and women with untreated atrioventricular conduction block. Europace. 2011 Jun 1;13(6):859-63.
14. Grover S, Sheth P, Haines DE, Khan M, Gonik B. Management of cardiac pacemakers in a pregnant patient. Open Journal of Obstetrics and Gynecology. 2014 Dec 25;5(01):60-9.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.