The online version of this article (doi:10.1186/1471-2253-14-49) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
VR: Preparation of the manuscript and involvement in the case. IIS: Anesthesiologist involved in the case. YKC: Conceived of the study, and participated in its design and coordination and helped to draft the manuscript. RKM: Preparation of the manuscript. KKW: Preparation of the manuscript. SS: Preparation of the manuscript. All authors read and approved the final manuscript.
Complete heart block in pregnancy has serious implications particularly during the period of delivery. This is more so if the delivery is an operative one as the presence of heart block may produce haemodynamic instability in the intra operative period. We report a unique case of a pregnant mother with complete heart block undergoing hysterostomy, complicated by placenta accreta and intrauterine death.
A 37 year old Malaysian Chinese parturient was admitted at 25 weeks gestation following a scan which suggested intrauterine death and placenta accreta. She was diagnosed to have congenital complete heart block after her first delivery eight years previously but a pacemaker was never inserted. These medical conditions make her extremely likely to experience massive bleeding and haemodynamic instability. Among the measures taken to optimise her pre-operatively were the insertion of a temporary intravenous pacemaker and embolization of the uterine arteries to minimize peri-operative blood loss. She successfully underwent surgery under general anesthesia, which was relatively uneventful and was discharged well on the fourth post-operative day.
Congenital heart block in pregnancies in the presence of potential massive bleeding is best managed by a team, with meticulous pre-operative optimization. Suggested strategies would include insertion of a temporary pacemaker and embolization of the uterine arteries to reduce the risk of the patient getting into life threatening situations.
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- Peri-operative management of hysterostomy in a parturient with complete heart block, placenta accreta and intrauterine death
Ina I Shariffuddin
Yoo K Chan
Rajesh K Muniandy
Kang K Wong
- BioMed Central
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