Complete Heart Block In Pregnancy And Manual Removal Of The Placenta After Vaginal Delivery

Abstract

Management of the risk for cardiovascular and obstetrical complications is difficult in pregnant  women with complete heart block. Complete congenital or acquired atrioventricular block  can detected  for the first time during pregnancy and delivery but only few cases have been reported in the literature. The first case was reported in 1914 by Nanta [1]. The acquired variety is very  rare during pregnancy as this type is mostly seen after 50 years of age[2].During pregnancy acquired heart block may be due to myocarditis, collagen vascular diseases ,following infective endocarditis of aortic valve with root abscess or as a complication of cardiac surgery. In acquired heart block, heart rate is usually 40 or less per minute with wide QRS in ECG. They are usually symptomatic with temporary loss  of consciouness in the form of presyncope or syncope[3]. The prognosis is generally worse, but ultimately depends on the underlying cause [4]. Complete atrioventricular block detected  for the first time during pregnancy  is usually congenital. With an incidence of 1 in 20,000 live born infants [5],congenital complete atrioventricular block is a rare disease. The aetiology is not completely understood. However, complete atrioventricular block may be isolated or combined with congenital heart diseases in up to 53% of affected individuals[6] It may be caused by cardiac malformations or damaged by maternal antibodies .Family history of complete atrioventricular block is one of the risk factor for congenital atrioventricular block [7-8].