Fetal arrhythmias are not uncommon in pregnancy. The diagnosis can be established on routine ultrasound scan. Fetal supraventricular tachycardia (SVT) is the most common cause of fetal tachycardia. If left undiagnosed and untreated, these fetuses may develop cardiac failure, hydrops fetalis and eventually death. We report two fetuses diagnosed antenatally to have fetal SVT. Both fetuses were in cardiac failure and were successfully treated with maternal administration of antiarrhythmic medications. Digoxin, and in severe instances, a combination with flecanaide significantly improved fetal outcomes and prevented fetal mortality. The long term prognosis of such patients are good.
Mirror syndrome is a rare clinical condition in pregnancy associated with significant fetal mortality and maternal morbidity. It is characterized by a triad of complications: fetal hydrops, placenta oedema, and maternal oedema. We are reporting one case of late-onset Mirror syndrome in which the patient presented later in the gestation of 36 weeks due to excessive weight gain and clinical sign mimicking preeclampsia. Awareness of this disease is essential, as a failure of recognition will delay the treatment and cause higher maternal and perinatal morbidity and mortality.
Objectives: To evaluate the cost-effectiveness of the new oxytocin regimes in the augmentation of labour and the effect on the maternal and fetal outcome. Design: Randomized controlled trial. Setting: Labour ward of Hospital Tengku Ampuan Afzan, Kuantan. Participants: 230 pregnant women in labour at term with obstetric indications for labour augmentation. Methods: The women were randomly assigned to receive new oxytocin regime of 5 units in 500 cc of D/Saline at titration of 5 dpm with increments of 5 dpm to a maximum of 60 dpm. Or, old oxytocin regime of 1/2/4 units with titration of 20/40/60 dpm for primips and half the dosage for multips.
Main outcome measures: Cost analysis, duration of labour, duration of augmentation, complication of labour, post partum hemorrhage (PPH), mode of delivery and perinatal outcome.
Results: There was no significant difference in the mean duration of labour (6.8 h vs 6.7 h ; p = 0.45) and mean augmentation time (3.86 h vs 4.0 h; p = 0.9) between the regimes studied There seemed to be higher incidence of caesarean section in the old oxytocin group (6.5% vs 24.7%; p = 0.001). There was no significant influence on the neonatal morbidity and mortality (p = 0.07). A moderate reduction of annual cost for augmentation of labour was noted (RM 962.34).
Conclusion: The results showed that the new oxytocin regime was more cost-effective without apparent increased in the maternal and fetal mortality and morbidity.