Anaesthetic management of twin pregnancy with complete heart block: A continuing dilemma
Background: Complete heart block (CHB) during pregnancy poses significant anesthetic challenges, particularly when associated with bradycardia, and in the absence of established perioperative management guidelines. Anesthesiologists must navigate the delicate balance of maintaining hemodynamic stabi...
Saved in:
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Sadra Danesh Negar
2025-03-01
|
| Series: | Journal of Preventive and Complementary Medicine |
| Subjects: | |
| Online Access: | https://www.jpcmed.com/article_216400_3b61086f27e5db631bbaa560774ec20d.pdf |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1839626497821769728 |
|---|---|
| author | Anju Rani Alka Dahiya Sudha Puhal Vasudha Govil Ritu Baloda Sudhir Bisherwal |
| author_facet | Anju Rani Alka Dahiya Sudha Puhal Vasudha Govil Ritu Baloda Sudhir Bisherwal |
| author_sort | Anju Rani |
| collection | DOAJ |
| description | Background: Complete heart block (CHB) during pregnancy poses significant anesthetic challenges, particularly when associated with bradycardia, and in the absence of established perioperative management guidelines. Anesthesiologists must navigate the delicate balance of maintaining hemodynamic stability while avoiding medications that could worsen bradycardia, requiring a personalized approach.Case Presentation: We present the case of a 26-year-old woman, G2P2L1, with a dichorionic diamniotic (DCDA) twin pregnancy. One fetus had intrauterine demise (IUD) at term, and the surviving twin was in a malpresentation. The patient had a history of congenital CHB with a baseline heart rate of 42–45 beats per minute but was asymptomatic and had never required a pacemaker. An emergency lower segment cesarean section (LSCS) under general anesthesia was performed due to the malpresentation of the surviving twin.Discussion: The anesthetic strategy aimed to maintain maternal hemodynamic stability and prevent further bradycardia. Careful avoidance of bradycardia-inducing agents, such as opioids and certain inhalational agents, was critical. Close intraoperative monitoring was implemented, with a cardiology team on standby for immediate intervention if required. This case highlights the importance of multidisciplinary collaboration, hemodynamic optimization, and careful anesthetic planning in managing pregnant patients with CHB. The lack of established guidelines necessitates individualized management to ensure maternal and fetal safety. |
| format | Article |
| id | doaj-art-f6e8c84bd977482aafb26f754c4e6a0a |
| institution | Matheson Library |
| issn | 3041-9700 3041-9921 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Sadra Danesh Negar |
| record_format | Article |
| series | Journal of Preventive and Complementary Medicine |
| spelling | doaj-art-f6e8c84bd977482aafb26f754c4e6a0a2025-07-17T09:49:12ZengSadra Danesh NegarJournal of Preventive and Complementary Medicine3041-97003041-99212025-03-0141606410.22034/jpcm.2025.507628.1208216400Anaesthetic management of twin pregnancy with complete heart block: A continuing dilemmaAnju Rani0Alka Dahiya1Sudha Puhal2Vasudha Govil3Ritu Baloda4Sudhir Bisherwal5Department of Anaesthesiology and critical care, Pt.B.D.Sharma PGIMS Rohtak (Haryana) – 124001, IndiaDepartment of Anaesthesiology and critical care, Pt.B.D.Sharma PGIMS Rohtak (Haryana) – 124001, IndiaDepartment of Anaesthesiology and critical care, Pt.B.D.Sharma PGIMS Rohtak (Haryana) – 124001, IndiaDepartment of Anaesthesiology and critical care, Pt.B.D.Sharma PGIMS Rohtak (Haryana) – 124001, IndiaDepartment of Anaesthesiology and critical care, Pt.B.D.Sharma PGIMS Rohtak (Haryana) – 124001, IndiaDepartment of Anaesthesiology and critical care, Pt.B.D.Sharma PGIMS Rohtak (Haryana) – 124001, IndiaBackground: Complete heart block (CHB) during pregnancy poses significant anesthetic challenges, particularly when associated with bradycardia, and in the absence of established perioperative management guidelines. Anesthesiologists must navigate the delicate balance of maintaining hemodynamic stability while avoiding medications that could worsen bradycardia, requiring a personalized approach.Case Presentation: We present the case of a 26-year-old woman, G2P2L1, with a dichorionic diamniotic (DCDA) twin pregnancy. One fetus had intrauterine demise (IUD) at term, and the surviving twin was in a malpresentation. The patient had a history of congenital CHB with a baseline heart rate of 42–45 beats per minute but was asymptomatic and had never required a pacemaker. An emergency lower segment cesarean section (LSCS) under general anesthesia was performed due to the malpresentation of the surviving twin.Discussion: The anesthetic strategy aimed to maintain maternal hemodynamic stability and prevent further bradycardia. Careful avoidance of bradycardia-inducing agents, such as opioids and certain inhalational agents, was critical. Close intraoperative monitoring was implemented, with a cardiology team on standby for immediate intervention if required. This case highlights the importance of multidisciplinary collaboration, hemodynamic optimization, and careful anesthetic planning in managing pregnant patients with CHB. The lack of established guidelines necessitates individualized management to ensure maternal and fetal safety.https://www.jpcmed.com/article_216400_3b61086f27e5db631bbaa560774ec20d.pdfcomplete heart blockcongenital heart blockpregnancytwin pregnancygeneral anesthesia |
| spellingShingle | Anju Rani Alka Dahiya Sudha Puhal Vasudha Govil Ritu Baloda Sudhir Bisherwal Anaesthetic management of twin pregnancy with complete heart block: A continuing dilemma Journal of Preventive and Complementary Medicine complete heart block congenital heart block pregnancy twin pregnancy general anesthesia |
| title | Anaesthetic management of twin pregnancy with complete heart block: A continuing dilemma |
| title_full | Anaesthetic management of twin pregnancy with complete heart block: A continuing dilemma |
| title_fullStr | Anaesthetic management of twin pregnancy with complete heart block: A continuing dilemma |
| title_full_unstemmed | Anaesthetic management of twin pregnancy with complete heart block: A continuing dilemma |
| title_short | Anaesthetic management of twin pregnancy with complete heart block: A continuing dilemma |
| title_sort | anaesthetic management of twin pregnancy with complete heart block a continuing dilemma |
| topic | complete heart block congenital heart block pregnancy twin pregnancy general anesthesia |
| url | https://www.jpcmed.com/article_216400_3b61086f27e5db631bbaa560774ec20d.pdf |
| work_keys_str_mv | AT anjurani anaestheticmanagementoftwinpregnancywithcompleteheartblockacontinuingdilemma AT alkadahiya anaestheticmanagementoftwinpregnancywithcompleteheartblockacontinuingdilemma AT sudhapuhal anaestheticmanagementoftwinpregnancywithcompleteheartblockacontinuingdilemma AT vasudhagovil anaestheticmanagementoftwinpregnancywithcompleteheartblockacontinuingdilemma AT ritubaloda anaestheticmanagementoftwinpregnancywithcompleteheartblockacontinuingdilemma AT sudhirbisherwal anaestheticmanagementoftwinpregnancywithcompleteheartblockacontinuingdilemma |