Objective
The management of women presenting with with complete heart block during pregnancy remains very challenging. Untill now, there is not an established consensus for the most appropriate anaesthetic technique for caesarean section in women with complete atrioventricular block.
Methods
On our case, the atrioventricular complete heart block was diagnosed on the preoperative routine test for Caesarian Section due to cephalo-pelvic disproportion. The patient had no rregular antenatal check ups at a local hospital. Her parents reported rare episodes of syncope during childhood and adolescence and one more episode two year before. During pregnancy she did not report any sincope episode except from being tired .
Results
For obstetric reasons caesarean section was performed successfully under spinal anaesthesia with continuous monitorization during intraoperative time without a pacemaker .Even though the patient reacted well during administration of atropine a temporary pacemaker was found to be in case we would need it. A healthy baby boy of 3350 gram was delivered. During postpartum period the patient did not have any complains or syncope episodes. It was strongly recommended to her a regular follow up to cardiology department.
Conclusion
As suggested by our case, asymptomatic atrioventricular complete heart block in pregnancy can be managed successfully without pacemaker. However, careful monitoring, is necessity by the pregnancy heart team with a cardiologist, anaesthetist and obstetrician, with experience in the management of high risk pregnancies. Management of the risk for cardiovascular and obstetrical complications is difficult in pregnant women with complete heart block. Asymptomatic complete heart block in late pregnancy should be managed without pacemaker by the pregnancy heart team with a cardiologist, anaesthetist and obstetrician, with experience in the management of high risk pregnancies.
Keywords
Pregnanacy, complete atrio ventricular heart block,temporary pacing,obstetrical complication