UK Midwifery Archives
These archives contain extracts from discussions held on the UK Midwives and Consumers email list, a discussion group for people interested in midwifery in the UK. Open to midwives, students, mothers, and anyone interested in improving maternity services in UK. Posts in these archives express the views of the individual authors, and not those of the Association of Radical Midwives.
Foetal Heart Rate Anomalies
Anyone have any information on outcomes for fetus diagnosed with translocation of the great vessels, picked up at 33/40 due to abnormal heart sounds when using sonicaid in a routine antenatal check. (coupling, dropped and extra beats)
Does the baby have Fallot’s tetralogy, or just the transposition of the vessels? If there is no ASD or VSD then I would think the outcome would be quite poor.
I just met a couple whose first grandchild was diagnosed with the above in utero, and delivered at John’s Hopkin’s (tertiary level hosp. in Baltimore) so that neonatal surgery could be done in the first few days. The surgery went well, and said child is now risking life and limb on ski slopes at age 10. Suggest, perhaps, that the parents consider carefully where they plan to deliver (as opposed to what might be recommended as first option). And to be prepared for the unexpected. At our small DGH (you know I mean small!) we recently delivered a seriously compromised baby who was known to need cardiac surgery and it took nearly 24 hours to arrange an appropriate transfer…you can imagine the anxiety of parents and staff alike!
I had a client whose baby was diagnosed as having ‘atrial flutter’ and was whipped off to theatre for an emergency caesarean as soon as she stepped through the antenatal clinic doors.
After reading the thread on this topic, I returned to SCBU (special care baby unit) and asked a little more about what happened – the client I cared for had been transferred to the regional SCBU – and the message had come back that she need never have had the caesarean (Bearing in mind she had had a normal birth first time round). I thought it unnecessary to enlighten her, since she had already been through the CS. The baby is thriving – but on digoxin. I will know next time round, if I EVER see this condition again!
I recently attended a fetal monitoring in practice study day run by Donald Gibb and S. Arulkumaran. Two different situations were discussed where a fetal tacycardia was noticed. The first tachycadia was picked up antenatally, everything else was normal, eg size and fetal movements. A diagnosis of subraventricular tachycaria was made the mother was prescibed double the adult dose of digoxin. The following day the fetal heartrate had reverted to normal, normal birth two weeks later, no problems. The other baby’s tachycardia was detected in labour with no other distress signs or problems. During second stage fetal heart rate returned to normal. These are both discussed in ‘Fetal monitoring in practice ‘ D. Gibb & S.Arulkumaran.
Obviously I was not involved with the care of these two babies who have been discussed. But to my mind, if their heart arrythmias were compromising their health enough to warrant a c/section, then wouldn’t the baby be showing other signs of being unwell, eg. decreased fetal movements.? I have been involved in the care of a baby with supraventricular tachycardia, which is a different arrythmia to atrial fibrillation. That baby was delivered vaginally, into immediate paediatric care.
Just as an aside, in both my pregnancies I never had the fetal heartbeat auscultated by my primary caregiver (who happened to be an obstetrician). He always asked if the baby had been active or not. I have always worked under the assumption that hearing a fetal heartbeat in the abscence of any other reassuring signs (movements etc) only tells me that the baby is alive right now.
Is an atrial flutter a consistant change in the heart beat or is it intermittent? Was it “luck” that the midwives listened to the FH when they did? Could this have been going on for some time or was a change noticed from say 30wks to the next check? Could this condition also be called an SVT in utero?
SVT and atrial flutter are different arrythmias. Back in the days when I worked in coronary care, I could probably explain the difference in 25 words or less! From memory, the difference is where the origin of the electrical impulse that stimulates the ventricular activity is. In SVT, I think the whole heart goes along at a rapid rate, in A.Flutter, the atria overbeat but the ventricles don’t respond to every atrial beat. Does that make sense?
AH updated 12 November 2000