1/42. role of fetal echocardiography in the management of isolated fetal heart block with ventricular rate <55 bpm.Persistent bradycardia is an uncommon cardiac problem in fetuses but carries a high mortality in those with a ventricular rate <55 bpm. fetal heart block is one of the most common causes of persistent fetal bradycardia (PFB). An optimal method for assessing and monitoring cardiovascular compensation in the setting of PFB due to heart block has not been fully established. We report the application of two-dimensional and Doppler echocardiography in close monitoring of cardiac function and hemodynamics in a third-trimester fetus with a ventricular rate <55 bpm due to heart block, which assisted in successful management of the pregnancy to term. Hemodynamic and cardiac adaptive changes in compromised fetuses, particularly due to heart block, are discussed.- - - - - - - - - - ranking = 1keywords = pregnancy (Clic here for more details about this article) |
2/42. The effect of maternal hypothermia on the fetal heart rate.Fetal bradycardia is a recognized response to maternal hypothermia but has not previously been reported in conjunction with diabetes. A 30-year-old insulin-dependent diabetic was admitted at 35 weeks gestation for control of her diabetes. She developed maternal hypothermia and hypoglycemia and the fetal heart rate fell to 100 beats per minute (b.p.m.). However, the fetal heart rate gradually returned to normal after rewarming the patient.- - - - - - - - - - ranking = 2.846215208659keywords = gestation (Clic here for more details about this article) |
3/42. Morbid hypocalcemia associated with phosphate enema in a six-week-old infant.A 6-week-old premature infant who was born at 29 weeks of gestation presented to the emergency department with a several-hour history of stiffness and increased alarms on his apnea monitor at home. On arrival he was noted to have generalized seizures, apnea, and bradycardia. He was intubated and required cardiopulmonary resuscitation including chest compressions and medications. After stabilization he was transferred to the neonatal intensive care unit for further management. His initial laboratory tests revealed a serum calcium level of 2.4 mg/dL (normal range: 8.4-10.2 mg/dL) and a serum phosphorus level of 28.5 mg/dL (normal range: 2.4-4.5 mg/dL). During the first week of admission, the infant's mother reported that she had administered a full pediatric Fleets enema (CB Fleet Company Inc, Lynchburg, VA) to him. The infant was discharged after 12 days of hospitalization. Anticipatory guidance on the stool patterns and behavior of infants can prevent misconceptions about constipation that are especially prevalent in new parents. Proper management of constipation, should it arise, should be addressed with all parents at early well-child visits to avoid hazardous complications of treatments. hypocalcemia, seizures, premature infants, enema.- - - - - - - - - - ranking = 2.846215208659keywords = gestation (Clic here for more details about this article) |
4/42. prenatal diagnosis of persistent fetal bradycardia: report of four cases.Persistent fetal bradycardia is infrequent in prenatal life and difficult to manage optimally. It is generally attributable to sinus bradycardia due to fetal distress, blocked atrial extrasystoles, and congenital complete heart block. We reported four cases of persistent fetal bradycardia from 1995 to 1999 in our hospital. The first, second, and third cases of sustained fetal bradycardia had congenital complete heart block with positive titers for anti-Ro/SSA antibodies in both mothers and fetuses. Because of progressive fetal hydrops in the second case, the pregnancy was terminated. The first and third cases were isolated congenital complete heart block without structural anomaly. After prenatal examination the babies were followed up closely until term and both had a good prognosis without any implantation of pacemaker. In the fourth case there was no clinically known etiology associated with sustained fetal bradycardia. The fetal heart rate returned to normal after 6 weeks of follow-up and the baby was delivered without any cardiac problems. Congenital complete heart block is the most common cause of persistent fetal bradycardia. Prenatal detailed monitoring until delivery is necessary before heart failure develops. Treatment strategies (corticosteroids, ritodrine, and plasmapheresis) are debatable and may include prophylactic therapy for high-risk pregnant women.- - - - - - - - - - ranking = 1keywords = pregnancy (Clic here for more details about this article) |
5/42. endotoxemia causing fetal bradycardia during urosepsis.BACKGROUND: Fetal bradycardia is a recognized response to maternal hypothermia associated with hypoglycemia, tocolysis with magnesium sulfate, or urosepsis, and it is thought to be a direct response to the decrease in the maternal core temperature. CASE: A 25-year-old white woman, gravida 1, para 0, at 31 1/7 weeks' gestation was admitted with a diagnosis of pyelonephritis. The baseline fetal heart rate was 120 beats per minute with accelerations. Within 3 hours of admission, the patient became hypothermic (35.1C) and, concomitantly, the fetal heart rate baseline declined to 90 beats per minute with marked variability. Despite sustained maternal hypothermia, the fetal heart rate baseline rose to 120 beats per minute. It was another 6 hours before the patient's temperature rose above 38.5C. Her urine and blood cultures were positive for serratia rubidacea infection. The patient delivered a healthy infant at 39 weeks' gestation. CONCLUSION: Fetal bradycardia in the presence of urosepsis might be due to the release of endotoxin from gram-negative bacteria, triggering production of cardiotoxic cytokines, rather than to maternal hypothermia alone.- - - - - - - - - - ranking = 5.692430417318keywords = gestation (Clic here for more details about this article) |
6/42. prenatal diagnosis of long qt syndrome using magnetocardiography: a case report and review of the literature.OBJECTIVES: To investigate the usefulness of magnetocardiography (MCG) in the prenatal diagnosis of fetal long qt syndrome. methods: Fetal MCG was recorded in a case of fetal long qt syndrome suspected in utero. The literature on the prenatal diagnosis of fetal long qt syndrome was also reviewed. RESULTS: The MCG was performed at 36 weeks' gestation because sustained fetal bradycardia of 110-120 bpm was detected by cardiotocography. The 64-channel MCG revealed a prolonged fetal corrected QT-interval of 0.57 s. The postnatal electrocardiogram coincided with prenatal MCG. CONCLUSION: An accumulation of cases of prenatally diagnosed long qt syndrome using MCG indicates that MCG may be the most reliable tool for the prenatal diagnosis of long qt syndrome.- - - - - - - - - - ranking = 2.846215208659keywords = gestation (Clic here for more details about this article) |
7/42. Favorable outcome in a pregnancy with complete fetal heart block and severe bradycardia.BACKGROUND:Pregnancies complicated by congenital heart block usually have a poor prognosis when there is severe fetal bradycardia.CASE:We present a pregnancy with fetal heart rate of 40 beats per minute. She previously delivered a child with third-degree heart block by cesarean at 28 weeks. This pregnancy was complicated by a high ribonucleoprotein antibody anti-Ro/SSA titer and fetal bradycardia. The patient was treated with steroids and beta-mimetics. The fetus continued to grow normally with reassuring biophysical profiles. After fetal lung maturity documentation at 34 weeks, she delivered by repeat cesarean a healthy 2349-g infant who required a permanent pacemaker.CONCLUSION:Reassuring antepartum testing and normal growth in pregnant women with anti-Ro/SSA antibodies and congenital heart block may allow expectant management until fetal maturity.- - - - - - - - - - ranking = 6keywords = pregnancy (Clic here for more details about this article) |
8/42. Fetal bradycardia in the first trimester: an unusual presentation of atrial extrasystoles.We report a fetus with fetal bradycardia at 13 weeks of gestation secondary to atrial extrasystoles. The fetus subsequently developed paroxysmal supraventricular tachycardia and hydrops fetalis. The cardiac arrhythmia recovered spontaneously without any medical intervention. This case illustrates that atrial ectopic beats can present in the first trimester with fetal bradycardia. Rapidly evolving hydrops fetalis secondary to supraventricular tachycardia can develop, warranting close monitoring with weekly heart rate assessment. Fetal bradycardia secondary to atrial extrasystole should be differentiated from first trimester sinus bradycardia and those associated with major structural cardiac abnormality, which have a high fetal loss rate.- - - - - - - - - - ranking = 2.846215208659keywords = gestation (Clic here for more details about this article) |
9/42. prenatal diagnosis and treatment of fetal long qt syndrome: a case report.We report a case of a fetus presenting with bradycardia, intermittent atrioventricular (AV) block, ventricular tachycardia (VT) and the signs of fetal congestive heart failure (ascites and scrotal hydrocele) during mid-gestation. Prenatal treatment with beta-adrenergic blocker (propranolol) and digitalis glycosides was prescribed because of suspicion of long qt syndrome occurring with fetal congestive heart failure. The male baby was born at 39 weeks of gestation and showed a prolonged QT interval (QTc = 492 ms) and frequent variable AV block or alternating left and right bundle branch block, depending on the atrial rate. Prenatal administration of lidocaine failed to correct the fetal VT. Conversely, propranolol decreased the attack frequency of fetal VT. Postnatal administration of the K( ) channel opener (nicorandil) successfully shortened the QT interval and improved the outcome.- - - - - - - - - - ranking = 5.692430417318keywords = gestation (Clic here for more details about this article) |
10/42. Isolated non-compaction of the ventricular myocardium: prenatal diagnosis and natural history.Isolated non-compaction of the ventricular myocardium (NCVM) is a rare cardiomyopathy characterized by the persistence of numerous marked ventricular trabeculations and deep intertrabecular recesses with direct vascular supply by the ventricular cavities. We report two cases diagnosed by fetal echocardiography at 27 and 30 weeks' gestation, respectively. Postnatal echocardiography verified the presence of the NCVM seen prenatally. Diagnosis was confirmed at postmortem following neonatal demise in the first case. Surgical intervention for exomphalos and extrahepatic biliary atresia was required in the second case, but there is no clinical abnormality of the cardiovascular system a year after delivery. The uncertainty of prognosis and the familial recurrence described elsewhere indicate the difficulty of counseling and the value of prenatal diagnosis, which is feasible using currently available ultrasonographic equipment.- - - - - - - - - - ranking = 2.846215208659keywords = gestation (Clic here for more details about this article) |
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