Amiodarone given by three routes to terminate fetal atrial flutter associated with severe hydrops.
BACKGROUND
We describe the concurrent administration of amiodarone using three different routes in order to provide: 1) rapid and adequate fetal loading without giving unduly high doses to the mother, and 2) a maintenance dose to the fetus without risking repeated invasive procedures.


METHODS
Rapid atrial flutter was seen on ultrasound in a fetus with severe hydrops at 27 weeks' gestation. Following failed transplacental therapy with sotalol and flecainide, amiodarone was administered to the fetus via the intravenous, intraperitoneal, and transplacental routes. Conversion to sinus rhythm and resolution of hydrops followed this treatment.


CONCLUSIONS
Combined triple-route administration of amiodarone to the fetus can be effective in treating supraventricular tachycardia and may have a role in the management of life-threatening fetal arrhythmias refractory to transplacental therapy.
Fetal Medicine Unit, Royal Postgraduate Medical School, Queen Charlotte's and Chelsea Hospital, London, United Kingdom.
N J
NJ
Flack
N
N
Zosmer
P R
PR
Bennett
J
J
Vaughan
N M
NM
Fisk
D000328:Adult; D000638:Amiodarone / Q000008:administration & dosage* / Q000627:therapeutic use; D001282:Atrial Flutter / Q000150:complications / Q000188:drug therapy*; D004333:Drug Administration Routes; D004487:Edema / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006801:Humans
D000638:Amiodarone