Fetal Long QT Syndrome – Challenges in Perinatal Management: A Review and Case Report. Induction of Labor and Vaginal Birth Under Continuous Magnesium Therapy

Abstract

Congenital LQTS is an often undetected inherited cardiac channel dysfunction and can be a reason for intrauterine fetal demise. It can present in utero as CTG and ultrasound abnormalities, i. e., bradycardia, ventricular tachycardia, or fetal hydrops. Diagnosis is made by CTG, echocardiography, or fMCG. Intrauterine therapy with a ß blocker and i. v. magnesium should be started. Our objective was to examine the current knowledge about diagnosis and treatment of LQTS and in particular to highlight the opportunity of vaginal birth under continuous intravenous magnesium therapy. Therefore, a thorough MEDLINE and Google Scholar search was conducted. Randomized controlled trials, meta-analyses, prospective and retrospective cohort trials, and case reports were considered. We showed the possibility of vaginal delivery under continuous magnesium therapy in a case of suspected fetal LQTS. A stepwise concept for diagnosis, monitoring, and peripartum management in low, intermediate, and high risk cases of fetal LQTS is presented. If risk is low or intermediate, a vaginal delivery under continuous monitoring is reasonable. Induction of labor at term should be evaluated.

Zusammenfassung

Das kongenitale LQTS ist eine häufig unerkannte genetisch erworbene kardiale Ionenkanalerkrankung, die Ursache für einen intrauterinen Fruchttod sein kann. Im CTG oder im pränatalen Ultraschall können sich Auffälligkeiten wie Bradykardien, ventrikuläre Tachykardien oder ein Hydrops fetalis zeigen. Die Diagnose wird regelhaft mittels CTG, Echokardiagraphie oder fMCG gestellt. Eine intrauterine Therapie mit Betablockern und intravenöser Magnesiumgabe sollte begonnen werden. Das Ziel der vorliegenden Arbeit ist die Aufarbeitung des aktuellen Forschungsstandes zur Diagnosestellung und Therapie des LQTS sowie darüber hinaus die Präsentation einer vaginalen Geburt bei vermutetem fetalen LQTS unter kontinuierlicher intravenöser Magnesiumtherapie. Es erfolgte eine detaillierte PUBMED und Google Scholar Recherche. Randomisiert kontrollierte Studien, Metaanalysen, prospektive und retrospektive Kohortenstudien sowie Fallberichte wurden eingeschlossen. Wir zeigen die Möglichkeit einer vaginalen Geburt unter intravenöser Magnesiumtherapie bei vermutetem fetalen LQTS. Außerdem präsentieren wir ein schrittweises Konzept für Diagnosestellung, Überwachung und peripartaler Entscheidungsfindung für Niedrig-, Intermediär- und Hochrisikofälle. Im Falle eines niedrigen oder intermediären Risikos ist der Versuch einer vaginale Geburt unter kontinuierlicher Magnesiumtherapie eine vertretbare Entscheidung. Die Geburtseinleitung am Termin sollte evaluiert werde.

Keywords

ultrasound - obstetrics - antenatal care - management - neonatology - foetal heart rate

Schlüsselwörter

Fetale Überwachung - Ultraschall - Geburtshilfe - Neonatologie - Management - fetale Herzfrequenz

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