digoxin and Diseases-in-Twins

A case of a twin pregnancy in which one fetus developed hydrops secondary to supraventricular tachycardia was detected at 21 weeks' gestation. Transplacental digoxin therapy successfully converted the supraventricular tachycardia to a normal sinus rhythm without evidence of maternal or fetal side-effects. The pregnancy proceeded to term and elective cesarean section was carried out at 37 weeks' gestation.

Topics: Adult; Cesarean Section; Digoxin; Diseases in Twins; Fatal Outcome; Female; Fetal Diseases; Gestational Age; Humans; Hydrops Fetalis; Male; Pregnancy; Pregnancy Outcome; Pregnancy, Multiple; Tachycardia, Supraventricular; Ultrasonography, Prenatal

There are a lot of publications about fetal arrhythmia in singletons, but up to now there are no published data about fetal arrhythmia in multiple pregnancies. In the present study a case history of fetal and neonatal arrhythmia in one of twins from two mothers treated with betamimetic agents due to imminent preterm labor is reported and discussed. A first case with fetal bradycardia due to complete A-V block had congenital cordis abnormalities (VSD and PFO). The second case with prenatal detected extrasystoles had normal heart anatomy. Digoxin was administered to the mother, in the aim to treat fetal arrhythmia without success, because the baby had postnatal bradycardia. After hospitalisation in Cardiology Department the described cases were successfully treated. In both cases the second twins were without neonatal arrhythmia and with no structural heart abnormalities. We summarise that in situation of detection fetal arrhythmia the complexity of the problems experienced may warrant early referral to a tertiary centre where the overall management of the mother, fetus and neonate, may be undertaken.

Topics: Arrhythmias, Cardiac; Bradycardia; Cardiac Complexes, Premature; Digoxin; Diseases in Twins; Female; Fetal Diseases; Fetal Heart; Gestational Age; Heart Block; Humans; Infant, Newborn; Infant, Newborn, Diseases; Male; Obstetric Labor, Premature; Pregnancy; Twins; Ultrasonography, Prenatal

Hydrops fetalis thought to be due to Ebstein's anomaly was seen at 22 weeks' gestation in one of two fetuses with a monochorionic placenta. Hydrops was treated with maternal digitalization and resolved by the 28th week of gestation. Hydrops did not recur while maternal digitalization continued. A clinical diagnosis of twin-to-twin transfusion syndrome required termination of the pregnancy at 33 weeks of gestation. The twin with Ebstein's anomaly died 22 hours after birth. The other twin survived and was normal at 19 months of age. Thus, administration of digitalis to the mother controlled hydrops fetalis in one fetus, and ultimately led to the survival of the healthy infant.

Topics: Adult; Amniotic Fluid; Digoxin; Diseases in Twins; Ebstein Anomaly; Female; Fetal Death; Humans; Hydrops Fetalis; Pregnancy

Topics: Digoxin; Diseases in Twins; Female; Fetal Diseases; Heart Failure; Humans; Maternal-Fetal Exchange; Pregnancy