Refractory fetal supraventricular tachycardia and obstetric cholestasis.

OBJECTIVE

Supraventricular tachycardia (SVT) is the most common form of sustained fetal tachyarrhythmia in pregnancy. The development of hydrops with SVT is associated with significant worsening of prognosis.

METHODS

We report a case of fetal SVT with hydrops at 28 weeks' gestation that required both transplacental and direct fetal treatment in a woman with concurrent obstetric cholestasis. Antiarrhythmic therapy and control of the maternal liver function and bile acid levels with ursodeoxycholic acid was associated with a fetal response to treatment resulting in a healthy term live birth.

CONCLUSIONS

Fetal SVT and hydrops fetalis are associated with significant perinatal morbidity and mortality. Resistance to intensive antiarrhythmic therapies may be augmented by the myocardial effects of obstetric cholestasis and remains a challenge for management.