Hepatic venous Doppler in the evaluation of fetal extrasystoles

To evaluate the use of fetal hepatic venous Doppler in the diagnosis of fetal extrasystoles, to estimate the prevalence and persistence of extra atrial and ventricular heart beats throughout pregnancy, labor and delivery, and to estimate the frequency of coexisting congenital heart disease.

This was a retrospective study of 256 singleton pregnancies attending our hospital as outpatients due to fetal extrasystoles. Hepatic venous Doppler and detailed fetal echocardiography were performed. Information on fetal heart rate patterns during labor and neonatal conditions was collected. Congenital heart malformations and the frequency and persistence of fetal extrasystoles were noted.

On venous Doppler examination, 228 (89%) of the fetuses showed signs of supraventricular extrasystoles (SVES) and 28 (11%) had ventricular extrasystoles (VES). One fetus with SVES developed atrial flutter during pregnancy and another case developed supraventricular tachycardia postnatally. SVES persisted until labor and delivery in 28 (12.3%) fetuses and VES persisted in six (21.4%). In 31 of 34 (91.2%) fetuses with extrasystoles during labor and delivery, the conduction pattern normalized within 3 days. Five neonates were referred for evaluation by a pediatric cardiologist. Two cases had congenital heart disease. Extrasystoles persisted until labor and delivery more frequently in male fetuses (P < 0.0001).

Hepatic venous Doppler can differentiate between SVES and VES. Despite being the more uncommon of the two, VES persists throughout pregnancy more often. Our results strongly support the suggestion that extrasystoles are a benign finding, with very few cases developing tachycardia or having a coexisting congenital heart malformation.