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Published on: October 25, 2015
Refractory fetal supraventricular tachycardia and obstetric cholestasis
Antonia W Shand1, Jan E Dickinson, Luigi D'Orsogna
1Maternal Fetal Medicine Service, King Edward Memorial Hospital for Women, The University of Western Australia, Perth, WA, Australia.
Objective:
Supraventricular tachycardia (SVT) is the most common form of sustained fetal tachyarrhythmia in pregnancy. The development of hydrops with SVT is associated with significant worsening of prognosis.
Case:
We report a case of fetal SVT with hydrops at 28 weeks' gestation that required both transplacental and direct fetal treatment in a woman with concurrent obstetric cholestasis. Antiarrhythmic therapy and control of the maternal liver function and bile acid levels with ursodeoxycholic acid was associated with a fetal response to treatment resulting in a healthy term live birth.
Conclusion:
Fetal SVT and hydrops fetalis are associated with significant perinatal morbidity and mortality. Resistance to intensive antiarrhythmic therapies may be augmented by the myocardial effects of obstetric cholestasis and remains a challenge for management.
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