Fetal heart block: Vaginal delivery an option

Area of Science:

• Perinatal Medicine
• Maternal-Fetal Medicine
• Obstetrics

Background:

• Fetal heart block (FHB) is a rare condition affecting approximately 1 in 20,000 births.
• FHB is associated with significant risks of morbidity and mortality.
• Current literature often advocates for Cesarean section (CS) for delivery in cases of FHB.

Purpose of the Study:

• To review perinatal outcomes in newborns with FHB.
• To evaluate the safety and efficacy of vaginal delivery for selected FHB cases.
• To compare outcomes across different delivery methods: vaginal, planned CS, and unplanned CS.

Main Methods:

• Retrospective cohort study conducted between January 1, 2007, and June 30, 2020.
• Infant outcomes were analyzed based on delivery group: planned vaginal delivery, planned CS, and unplanned CS.
• Intrapartum fetal scalp lactate monitoring was utilized in selected vaginal delivery cases.

Main Results:

• The study included 23 newborns with FHB; one antepartum fetal death occurred.
• In the vaginal delivery group (12 planned), all liveborn infants had Apgar scores >7 at 5 minutes.
• Five of six infants requiring intubation were delivered via planned CS, suggesting potential benefits for vaginal delivery in selected cases.

Conclusions:

• Planned vaginal delivery appears to be a safe approach for selected fetuses diagnosed with FHB.
• Effective labor management, including serial fetal scalp lactate monitoring, is crucial.
• The involvement of senior clinicians is a key factor in achieving positive perinatal outcomes.