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Treatment of fetal supraventricular tachycardia by intra-amniotic administration of digoxin. Fetal arrhythmias occur in as many as 1- 3% of pregnancies1 . Supraventricular tachycardia (SVT) accounts for about 66-90% of fetal tachyarrhythmia2 . First-line therapy has not been determined in randomized trials, but digoxin has been considered the first-choice drug. Flecainide and sotalol have been advocated as second-choice drugs, though flecainide might be more effective as a first-line treatment3
Morphine-induced supraventricular tachycardia in near-term fetusFetal supraventricular tachycardia (SVT), characterized by fetal heart rate between 220 and 260 bpm, is a rare but most commonly encountered fetal cardiac arrhythmia in pregnancy that may be associated with adverse perinatal outcome.We describe a 36/6 week near term fetus who presented morphine-induced SVT after maternal treatment of a renal colic. Following emergency cesarean section, the neonate had resolution of symptoms.The (...) pathophysiology of morphine-related SVT, previously documented in experimental animal models, and for the first time reported in the human fetus, is presented.
Potential utility of pulsed Doppler for prenatal diagnosis of fetal ventricular tachycardia secondary to long QT syndrome. 28741754 2018 10 19 2018 10 19 1469-0705 51 5 2018 May Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology Ultrasound Obstet Gynecol Potential utility of pulsed-wave Doppler for prenatal diagnosis of fetal ventricular tachycardia secondary to long QT syndrome. 697-699 10.1002/uog.18819 Miyoshi (...) , 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan. Ikeda T T Department of Obstetrics and Gynecology, Mie University, Tsu, Japan. eng Case Reports Letter England Ultrasound Obstet Gynecol 9108340 0960-7692 0 Anti-Arrhythmia Agents 7487-88-9 Magnesium Sulfate IM Adult Anti-Arrhythmia Agents administration & dosage Cesarean Section Electrocardiography Female Fetal Heart diagnostic imaging Humans Long QT Syndrome diagnostic imaging drug therapy Magnesium Sulfate administration & dosage Pregnancy
Transient FetalTachycardia After Intravenous Diphenhydramine Administration. Fetaltachycardia is attributable to a variety of etiologies, including an untreated maternal medical condition or an indicator of potential fetal compromise. Maternal medication administration may also affect the fetal heart rate.A 28-year-old nulliparous patient at 41 weeks of gestation was treated for pruritus with intravenous diphenhydramine after epidural administration of fentanyl. Within 14 minutes, the fetal (...) heart rate increased from a baseline of 155 beats per minute (bpm) to more than 200 bpm while maintaining moderate variability. This was accompanied by an increase in uterine contractions occurring every 1.5 minutes. The fetaltachycardia lasted 51 minutes; several hours later, a healthy neonate was delivered.Diphenhydramine may produce transient fetaltachycardia as well as increased maternal uterine activity.
heart rate up to 300 beats per minute due to supraventricular tachyarrhythmia (SVA) in the unborn baby (fetus). Although fetal SVA, including AF and other forms of SVT, is the most common cause of intended in-utero fetal therapy, our knowledge of drug effects on the baby and the co-treated mother is still limited. The Fetal Atrial Flutter and Supraventricular Tachycardia (FAST) Therapy Trial is a prospective multi-center trial to address this knowledge gap in order to guide future patient management (...) Prospective Observational Cohort Study of Fetal Atrial Flutter & Supraventricular Tachycardia Prospective Observational Cohort Study of Fetal Atrial Flutter & Supraventricular Tachycardia - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one
Postnatal Outcomes of Fetal Supraventricular Tachycardia: a Multicenter Study. Supraventricular tachycardia (SVT), the most common fetaltachycardia, can be difficult to manage in utero. We sought to better understand predictors of the postnatal clinical course in neonates who experienced fetal SVT. We hypothesized that fetuses with hydrops or those with refractory SVT (failure of first-line SVT therapy) are more likely to experience postnatal SVT. This was a retrospective multicenter cohort (...) study of subjects diagnosed with fetal SVT between 2006 and 2014. Fetuses with structural heart disease were excluded. Descriptive comparative statistics and univariate analysis with logistic regression were utilized to determine factors that most strongly predicted postnatal SVT and preterm delivery. The cohort consisted of 103 subjects. Refractory SVT was found in 37% (N = 38) of the cohort with this group more likely to be delivered prematurely (median = 36 vs. 37.5 weeks, p = 0.04). Refractory
and morbidities in term infants. We further identified patterns prior to delivery, alone or in combination, predictive of acidemia and neonatal morbidity.This was a prospective cohort study of 8580 women from 2010 through 2015. Patients were all consecutive women laboring at ≥37 weeks' gestation with a singleton cephalic fetus. Electronic fetal monitoring patterns during the 120 minutes prior to delivery were interpreted in 10-minute epochs. Interpretation included the category system and individual (...) minutes of tachycardia had the greatest discriminative ability for neonatal morbidity (area under the receiver operating characteristic curves, 0.77; 95% confidence interval, 0.75-0.79). Once the threshold of deceleration area is reached the number of cesareans needed-to-be performed to potentially prevent 1 case of acidemia and morbidity is 5 and 6, respectively.Deceleration area is the most predictive electronic fetal monitoring pattern for acidemia, and combined with tachycardia for significant
changes–peak activity in afternoon and evening from 20 weeks o Activity–sleep cycles occur day and night for 20–40 minute; rarely exceed 90 minutes in healthy fetus 11 · No definite conclusions about normal fetal movements in multiple pregnancies 16 Factors affecting fetal movements · Patterns change as fetus develops o Movements become more organised (increased motor co-ordination resulting in slower more powerful gross movements) 14 · External stimuli (e.g. acoustic stimuli 17 may increase, decrease (...) consider referral for obstetric ultrasound scan (USS) to assess growth and exclude fetal neuromuscular condition Decreased or abnormal fetal movements Aspect Consideration Clinical assessment · Perform assessment of woman and fetus as soon as possible within two hours of presentation including: o Review current pregnancy, medical and previous obstetric history o Review any previous USS for fetal growth assessment as plotted on growth charts 5 o Consider woman’s risk factors for fetal compromise
intrapartum CTG is unclear and may be related to the fetus moving less Normal intrapartum Term 1 · Baseline FHR of 110–160 bpm · Normal baseline variability present · Accelerations may or may not be present · No decelerations Preterm 28 · Baseline fetal heart at 20–24 weeks averages 155 bpm decreasing with advancing gestational age · Baseline rate will be around the upper limits of normal o Tachycardia reduces with gestational age · Baseline variability may be reduced due to tachycardia in preterm fetus (...) . Description of normal FHR 16 Table 12. Compromised fetus 17 Table 13. Reversible causes of abnormal CTG 18 Table 14. Intrapartum fetal blood sampling 19 Table 15. Intrapartum fetal blood sampling results 20 Table 16. Paired umbilical cord sampling 21 Table 17 Cord blood sampling outcome 22 Table 18 Normal cord blood gas and lactate (at birth) 22 Queensland Clinical Guideline: Intrapartum fetal surveillance Refer to online version, destroy printed copies after use Page 7 of 30 1 Introduction The principal
Vibroacoustic stimulation for fetal assessment in labour in the presence of a nonreassuring fetal heart rate trace. Fetal vibroacoustic stimulation (VAS) is a simple, non-invasive technique where a device is placed on the maternal abdomen over the region of the fetal head and sound is emitted at a predetermined level for several seconds. It is hypothesised that the resultant startle reflex in the fetus and subsequent fetal heart rate (FHR) acceleration or transient tachycardia following VAS (...) provide reassurance of fetal well-being. This technique has been proposed as a tool to assess fetal well-being in the presence of a nonreassuring cardiotocographic (CTG) trace during the first and second stages of labour.To evaluate the clinical effectiveness and safety of VAS in the assessment of fetal well-being during labour, compared with mock or no stimulation for women with a singleton pregnancy exhibiting a nonreassuring FHR pattern.We searched the Cochrane Pregnancy and Childbirth Group's
Successful prenatal management of ventricular tachycardia and second-degree atrioventricular block in fetal long QT syndrome 28491768 2019 02 26 2214-0271 3 1 2017 Jan HeartRhythm case reports HeartRhythm Case Rep Successful prenatal management of ventricular tachycardia and second-degree atrioventricular block in fetal long QT syndrome. 53-57 10.1016/j.hrcr.2016.09.001 Miyake Akira A Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan. Sakaguchi Heima (...) , National Cerebral and Cardiovascular Center, Osaka, Japan. eng Case Reports 2016 09 21 United States HeartRhythm Case Rep 101656239 2214-0271 Congenital long QT syndrome Fetal magnetocardiography Prenatal management Ventricular arrhythmia Ventricular tachycardia/torsades de pointes 2017 5 12 6 0 2017 5 12 6 0 2017 5 12 6 1 epublish 28491768 10.1016/j.hrcr.2016.09.001 S2214-0271(16)30106-3 PMC5420015 J Am Coll Cardiol. 2009 Nov 24;54(22):2052-62 19926013 Ultrasound Obstet Gynecol. 2009 Oct;34(4):475-80
Digoxin Therapy of Fetal Superior Ventricular Tachycardia: Are Digoxin Serum Levels Reliable? Despite its seldom occurrence, fetaltachycardia can lead to poor fetal outcomes including hydrops and fetal death. Management can be challenging and result in maternal adverse effects secondary to high serum drug levels required to achieve effective transplacental antiarrhythmic drug therapy.A 33-year-old woman at 33 weeks of gestation with a diagnosis of a fetal sustained superior ventricular (...) tachycardia developed chest pain, shortness of breath, and bigeminy on electrocardiogram secondary to digoxin toxicity despite subtherapeutic serum drug levels. She required supportive care with repletion of corresponding electrolyte abnormalities. After resolution of cardiac manifestations of digoxin toxicity, the patient was discharged home. The newborn was discharged at day 9 of life on maintenance amiodarone.We describe an interesting case of digoxin toxicity with cardiac manifestations of digoxin
Minimal Use of Fluoroscopy to Reduce Fetal Radiation Exposure during Radiofrequency Catheter Ablation of Maternal Supraventricular Tachycardia Electrophysiologic procedures in the young engender concern about the potential long-term effects of radiation exposure. This concern is manifold if such procedures are contemplated during pregnancy. Catheter ablations in pregnancy are indicated only in the presence of an unstable tachycardia that cannot be controlled by antiarrhythmic agents (...) . This report describes the case of an 18-year-old pregnant woman and our stratagem to minimize irradiation of the mother and the fetus.
Supraventricular Tachycardia: Guideline For the Management of Adult Patients With CLINICAL PRACTICE GUIDELINE 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society Writing Committee Members* Richard L. Page, MD, FACC, FAHA, FHRS, Chair José A. Joglar, MD, FACC, FAHA, FHRS, Vice Chair Mary A. Caldwell, RN (...) 2015 and the American Heart Association Executive Committee in September 2015. The American College of Cardiology requests that this document be cited as follows: Page RL, Joglar JA, Caldwell MA, Calkins H, Conti JB, Deal BJ, EstesNAM3rd,FieldME,GoldbergerZD,HammillSC,IndikJH,LindsayBD,OlshanskyB,RussoAM,ShenW-K,TracyCM,Al-KhatibSM.2015ACC/AHA/ HRS guideline forthe managementof adultpatientswith supraventricular tachycardia: a report of the AmericanCollegeof Cardiology/AmericanHeart Association