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.
Eisenmenger's syndrome is a very rare condition in pregnant women. The incidence of ES is about 3% of the pregnant patients with congenital heart defects; however, it can be accompanied with high incidence of maternal and neonatal morbidity and mortality. Therefore, these patients should have efficient contraception or termination of pregnancy in the first trimester. We present two poorly-controlled consecutive pregnancies with good outcomes in a woman with ES to clarify the appropriate function of teamwork in the management of emergency situations in similar cases. Alongside teamwork, good prenatal care is also important because it can result in elective termination in higher gestational age of pregnancy.A 21-year old woman, Repeat II cesarean belonging to a very low socioeconomic class, with ES was admitted to the emergency ward of Imam Hossein teaching hospital affiliated to Shahid Beheshti University of Medical Sciences with labor pain and severe dyspnea in 28 weeks of pregnancy. Echocardiography indicated a PAP of 120 mmHg. The patient had supportive treatment in intensive care unit until she was discharged. Despite previous reports of poor pregnancy outcomes in women with ES, high quality and significant treatment through labor and postpartum period lead to good outcomes in both mother and neonate.
Introduction: Heterotopic pregnancy is the existence of both intrauterine pregnancy and ectopic pregnancy simultaneously. Heterotopic pregnancy (HP) has been a rare type of multifetal pregnancy. Heterotopic abdominal pregnancy (HAP) is a very rare diagnosis with very few reported cases. Case Presentation: We reported a rare case of HAP in a 32-year-old woman (G2L1) with a history of 13 weak amenorrhea and mild pelvic pain presenting with two live fetuses in the 13th week. The patient also did not mention any risk factor of ectopic pregnancy such as pelvic inflammatory disease, assisted reproductive techniques, endometriosis, and multiparity. Diagnosis of HAP was performed with the use of sonography and magnetic resonance imaging. We managed the patient with emergency laparotomy due to acute abdominal pain a few hours after admission. Laparotomy revealed the rupture of the left fimbria with 500 cc hemoperitoneum. The excision of the ectopic gestational sac in the cul-de-sac and left salpingectomy with preserving the intrauterine fetus was performed. The patient finally gave birth to one live term birth. Conclusions: Physicians should consider the possibility of HP in women with spontaneous pregnancy and abdominal pain. Both sonography and MRI should be performed to help timely diagnosis.
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