Nina Nonette P. Diansuy
Abstract
Sustained fetal cardiac arrhythmias can cause cardiovascular failure subsequently leading to nonimmune fetal hdyrops. This is a case of a 29-year old primigravid, who delivered via primary low segment cesarean section a live baby girl with fetal hydrops, 33 weeks by pediatric aging, 2100 grams, with an Apgar score of 5 becoming 7. The initial antenatal surveillance was unremarkable at 22 weeks age of gestation until she presented with an incidental finding of fetal hydrops (ascites, scalp edema) and fetal bradyarrhythmia (78-82 bpm) with occasional premature atrial contractions at 24 weeks age of gestation. Work-up for hydrops was negative for immunologic, structural, infectious and hematologic causes. Management of fetal sinus bradycardia with premature atrial contractions is only supportive and warrants close antenatal fetal surveillance because it is usually well-tolerated and spontaneously resolves before or after delivery. However, the presence of hydrops may be a marker of worsening cardiovascular function. The sinus bradycardia persisted postnatally with no structural defects or heart blocks on electrocardiogram and echocardiogram. Inotropic medications, such as dopamine, epinephrine and caffeine, were given to the newborn to increase the heart rate and was subsequently tapered down and discontinued. Serial abdominal examination showed decreasing abdominal girth from 32 cm at birth to 29 cm upon discharge after 30 days. Fetal heart rate improved from 80-98 beats per minute to 90-122 beats per minute, off any medications. Follow-up after 1 year showed an infant at par with developmental milestones expected for her age.