title: Management of labour and delivery in a woman with refractory supraventricular tachycardia.
abstract: Supraventricular tachycardia is uncommon in pregnancy. It is defined as intermittent pathological and usually narrow complex tachycardia >120 beats/min which originates above the ventricle, excluding atrial fibrillation, flutter and multifocal atrial tachycardia. It is usually self-limiting or relatively easily treated with most cases responding to physical or pharmacological therapies. We describe a case of a woman in the third trimester of pregnancy who developed treatment-resistant supraventricular tachycardia and required induction of labour and delivery to stop the arrhythmia. A multidisciplinary team approach with a critical care trained nurse and a midwife, continuous arterial blood pressure monitoring, transthoracic echocardiography, and neuraxial analgesia facilitated safe birth in the delivery suite and termination of the arrhythmia.
authors.affiliation: Department of Anaesthesia, The Royal Women's Hospital, Parkville, Victoria, Australia. Electronic address: Alicia.dennis@thewomens.org.au.
authors.forename: A T
authors.initials: AT
authors.lastname: Dennis
authors.affiliation: Department of Anaesthesia, The Royal Women's Hospital, Parkville, Victoria, Australia.
authors.forename: M D
authors.initials: MD
authors.lastname: Gerstman
mesh_terms: D000328:Adult; D000577:Amides; D000650:Amnion / Q000601:surgery; D016058:Analgesia, Patient-Controlled / Q000379:methods; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000767:Anesthesia, Epidural / Q000379:methods; D000773:Anesthesia, Obstetrical / Q000379:methods*; D000779:Anesthetics, Local; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D036861:Delivery, Obstetric / Q000379:methods*; D004077:Digoxin / Q000627:therapeutic use; D004417:Dyspnea / Q000209:etiology / Q000503:physiopathology; D004452:Echocardiography / Q000379:methods; D005221:Fatigue / Q000209:etiology / Q000503:physiopathology; D005260:Female; D005283:Fentanyl; D005424:Flecainide / Q000627:therapeutic use; D006801:Humans; D007743:Labor, Obstetric; D008790:Metoprolol / Q000627:therapeutic use; D010092:Oximetry / Q000379:methods; D010120:Oxytocics / Q000008:administration & dosage; D010121:Oxytocin / Q000008:administration & dosage; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000188:drug therapy* / Q000503:physiopathology; D000077212:Ropivacaine; D013617:Tachycardia, Supraventricular / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000889:Anti-Arrhythmia Agents; D010120:Oxytocics; D010121:Oxytocin; D004077:Digoxin; D000077212:Ropivacaine; D008790:Metoprolol; D005424:Flecainide; D005283:Fentanyl
keywords: Induction of labour; Pregnancy; Supraventricular tachycardia; Transthoracic echocardiography