It can be frightening to learn that your baby is suffering from an arrhythmia while you are pregnant. What does it actually mean?
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Arrhythmia refers to a irregular heart beat — one that is too fast or too slow, or something else. This anomaly may be discovered by your doctor during a routine ultrasound.
Most fetal arrhythmias can be ignored. Your doctor might want to closely monitor your baby because certain types could indicate a defect in the heart. These conditions can lead to fluid buildup in the baby’s body/tissues (hydropsfetalis), premature birth, or even death.
Fetal arrhythmias: Causes
It’s a wonderful experience to hear your baby’s heartbeat. It may be faster than your own. A normal fetal heart beat is between 110 and 160 beats per hour. It’s important to remember that fetal heart beats can vary from beat to beat and can change.
If a baby’s heart beat is slow or faster than normal, or if there are other issues, it could indicate that the baby needs additional monitoring.
Around 2 percent of pregnancies are affected by fetal arrhythmias. If you are:
Autoantibodies to Ro/SSA or La/SSB are present in patients with certain autoimmune diseases like Lupus or Sjogren’s.
- Phenylketonuria
- Pre-existing or gestational diabetes
- Previous pregnancy: Fetal heart block
- Take teratogenic drugs or other drugs
- Infections in the first trimester such as rubella or parvovirus b19 or cytomegalovirus
- A fetal anomaly was detected by an ultrasound
- In vitro fertilization made it possible to get pregnant
- Are pregnant with monochorionic (identical twins sharing one placenta).
A family history, chromosomal abnormalities, Down syndrome, Turner syndrome or trisomies 13 or 18 may increase the risk of your baby developing a heart defect. A baby with a first-degree relative (mom or dad) who has a heart defect is at three times the risk of developing one.
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Fetal arrhythmias might not always be due to a structural defect in the heart. They may instead be due to inflammation or electrolyte imbalances. Sometimes, the cause might not even be known.
How it is diagnosed
Your doctor may send you for more detailed imaging, called a fetal Echocardiogram. An echo is used to visualise the heart and blood flow.
The test is noninvasive, and performed by a trained sonographer as an abdominal ultrasound. Although fetal echos are possible as early as 12 week into pregnancy, they are less reliable after 17 to 18 weeks.
A pediatric cardiologist reviews the images of the echo. A specialist in maternal-fetal medicine may refer you to an additional monitor throughout your pregnancy if the echo results are not normal.
Different types of fetal arrhythmias
There are many fetal arrhythmias. It can be difficult to research them all on your own. Ask your doctor to explain the situation to you. This will help you to understand how your baby is feeling and which part of your heart is affected. These are the most common types of problems you might encounter:
Extrasystoles (PCs), or premature contractions
Premature contractions, which are most common in the second and the third trimesters of pregnancy, are the most common form of arrhythmia. Your baby can have extra heartbeats with PCs. These may originate from the atria (premature arial contractions or PACs), or the ventricles.
In some cases, PACs and PVCs may resolve themselves without any treatment. Surveiling ventricular tachycardia (SVT) may occur in 2 to 3 percent.
Tachyarrhythmias
It’s when a baby’s heart beat exceeds 160 beats per hour that it is called tachycardia. This is referred to as sustained tachycardia if it occurs more frequently than 50 percent of time. Hydrops, heart failure and polyhydramnios (too many amniotic fluid) may be caused by a heart beat that is too fast.
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Atrial flutter (heart rate between 220 to 300 beats per minutes) and SVT are two of the most common tachyarrhythmias.
Bradyarrhythmias
Bradycardia is a condition in which a baby’s heart beat falls below 110 beats per hour. Your baby must have a low heart rate for at least 10 minutes to be considered sustained bradycardia.
Transient fetal delays, which are shorter periods of slower heart beats, can be benign, especially during the second trimester. About 30 percent of cases with sustained bradycardia will resolve before birth.
Blocks of the Atrioventricular vessels
Atrioventricular blockages, also known as congenital heart blocks, can be referred to in different degrees. In the United States, approximately 1 in 20,000 babies are born with a complete block. This causes dangerous drops in heart rate.
Heart block can be caused by a congenital defect in the heart or maternal anti-Ro/SSA antibody exposure, such as neonatal lupus.
Treating fetal arrhythmias
Some fetal arrhythmias do not require special treatment. Your doctor may detect an irregular heartbeat at your appointment and refer you to a specialist who will monitor your baby’s heart throughout the remainder of your pregnancy. No further treatment is necessary if things improve or stabilize on their own.
The treatment of issues that need treatment will depend on:
- The cause
- Your health
- Your baby’s health
How far along your pregnancy?
Your doctor might decide to treat your baby while they are still in the womb, with medication or surgery. You may also be closely monitored to monitor the baby’s progress. For example, a complete blockage of the heart may be treated by doctors with steroids or medication like hydroxychloroquine.
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Your doctor will be able to explain the treatment and monitoring plan as it applies to you. Every baby, every pregnancy and every heart problem is different, so any treatment you receive will be tailored to your specific case.