Supraventricular tachycardia presenting in labour: A case report achieving vaginal birth and review of the literature

Abstract

Arrhythmias are one of the most common forms of cardiac disease presenting in pregnancy. Women with underlying arrhythmias may only present to health care professionals when they are pregnant. The most common type of sustained arrhythmia presenting in pregnancy is a supraventricular tachycardia (SVT). This can be difficult to diagnose, as symptoms such as palpitations, dizziness and shortness of breath are also common symptoms of pregnancy. We present the management of a woman who developed intrapartum SVT. Her case highlights the importance of considering the diagnosis in the antenatal period, the use of antiarrhythmic drugs, as well as the fact that achieving vaginal delivery is possible in correctly selected cases while the mother and baby remain stable.

Supraventricular Tachycardia in Pregnancy: Gestational and Labor Differences in Treatment

“…Sinus rhythm was achieved after the surgical procedure. A 33-year-old woman at eight days past her due date, presented to the hospital in labor [ 18 ]. The patient's initial heart rate was 225 BPM and eventually decreased to 105 BPM.…”

“…Nine hours after admission, the patient's heart remained at 200 BPM, and SVT was revealed through EKG. The physicians administered an epidural hoping to resolve the SVT [ 18 ]. Unfortunately, this method proved to be ineffective.…”

“…Unfortunately, this method proved to be ineffective. The patient was treated with IV adenosine, IV metoprolol (administered twice), and finally IV verapamil [ 18 ]. The IV verapamil ultimately resulted in the termination of the SVT.…”

“…When vagal maneuvers fail, medical management becomes the preferred treatment of choice [ 17 ]. SVT can present at any stage of pregnancy, including labor [ 18 ]. Due to this fact, the safest form of treatment should be considered to ensure the mother's safety and prevent adverse effects on the fetus [ 19 ].…”

Management of tachyarrhythmias in pregnancy – A review

“…Fortunately, intrapartum arrhythmias are extremely uncommon, even for women who might be considered higher risk, with a history of ventricular arrhythmia or preexcited tachycardia. [220][221][222] Women with a history of frequent PVCs with a burden exceeding 10% may have an increased rate of cardiovascular complications in the course of pregnancy, 220 and consideration should be given to periodic rhythm monitoring and cardiac telemetry during labor in this group. A history of non-sustained or sustained ventricular arrhythmia, cardiac arrest, or pre-excited atrial fibrillation should prompt referral to a center capable of intrapartum telemetry monitoring.…”