Download PDF
CC BY-NC-ND 4.0 · AJP Rep 2020; 10(04): e380-e385
DOI: 10.1055/s-0040-1718900
Case Report

Fetal Tachycardia in the Delivery Room: Fetal Distress, Supraventricular Tachycardia, or Both?

Satvinder Singh Bhatia
1   Paediatric and Neonatal Services, North Shore Hospital, Auckland, New Zealand
2   Department of Paediatrics, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
,
Wendy H. Burgess
3   North Shore Hospital, Auckland, New Zealand
4   Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
,
Jonathan R. Skinner
5   The Childrens Hospital at Westmead, Sydney Children's Hospital Network, Sydney, NSW Australia
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Background Supraventricular tachycardia (SVT) is seldom considered a cause for fetal tachycardia; commoner etiologies including maternal fever and fetal distress are usually envisaged. Fetal arrhythmia can be missed as a diagnosis, potentially leading to suboptimal management.

Cases Three cases are described where detection of fetal tachycardia >200 beats per minute (bpm) at 36, 40, and 38 weeks gestation resulted in emergency cesarean section for presumed fetal distress. Retrospective review of the cardiotocograph in two cases revealed baseline heart rates 120 to 160 bpm, with loss of trace associated with auscultated rates over 200 bpm. The diagnosis of SVT was not initially considered and made later when the infants required cardioversion at the age of 3 weeks, 2 days, and 8 days, respectively. The 36-week infant required noninvasive ventilation for prematurity.

Conclusion SVT should be actively considered in the differential diagnosis of fetal tachycardia. Unrecognized fetal SVT may result in avoidable caesarean for suspected fetal distress, with potential prematurity-related problems. The cardiotocograph can be helpful if showing contact loss associated with rapid heart rate auscultation. The antenatal detection of fetal SVT is important as it can allow anticipation and prevention of neonatal SVT, which is potentially life-threatening if not detected and treated promptly.

Keywords

fetal distress - fetal arrhythmia - fetal SVT - neonatal SVT

Statement of Ethics

This research has been registered and has locality authorization with the Waitemata District Health Board, Auckland, New Zealand. Registration number RM13912.


The parents of the infants in case 1 and case 2 were contacted about the research and have given their consent for their infants to be included in this study. An attempt was made to contact the family of the infant in case 3 via their midwife, and they were unable to be contacted due to the family moving overseas.




Publication History

Received: 26 July 2020

Accepted: 21 August 2020

Article published online:
16 November 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Simpson LL. Fetal supraventricular tachycardias: diagnosis and management. Semin Perinatol 2000; 24 (05) 360-372
    CrossrefPubMedGoogle Scholar
  • 2 Skinner JR, Sharland G. Detection and management of life threatening arrhythmias in the perinatal period. Early Hum Dev 2008; 84 (03) 161-172
    CrossrefPubMedGoogle Scholar
  • 3 Chu PY, Hill KD, Clark RH, Smith PB, Hornik CP. Treatment of supraventricular tachycardia in infants: analysis of a large multicenter database. Early Hum Dev 2015; 91 (06) 345-350
    CrossrefPubMedGoogle Scholar
  • 4 Simpson LL, Marx GR, D'Alton ME. Supraventricular tachycardia in the fetus: conservative management in the absence of hemodynamic compromise. J Ultrasound Med 1997; 16 (07) 459-464
    CrossrefPubMedGoogle Scholar
  • 5 Gimovsky ML, Nazir M, Hashemi E, Polcaro J. Fetal/neonatal supraventricular tachycardia. J Perinatol 2004; 24 (03) 191-193
    CrossrefPubMedGoogle Scholar
  • 6 Moodley S, Sanatani S, Potts JE, Sandor GGS. Postnatal outcome in patients with fetal tachycardia. Pediatr Cardiol 2013; 34 (01) 81-87
    CrossrefPubMedGoogle Scholar
  • 7 Hinkle KA, Peyvandi S, Stiver C. et al. Postnatal outcomes of fetal supraventricular tachycardia: a multicenter study. Pediatr Cardiol 2017; 38 (07) 1317-1323
    CrossrefPubMedGoogle Scholar