Pregnancy Outcomes in Women with Complete Heart Block: Experience from a Tertiary Care Hospital.

Background: Pregnancy in women with complete heart block (CHB) poses a substantial challenge. We share our experience of managing pregnancies in patients with CHB.

Methods: In this case series, outcome of 12 pregnancies in 10 women with PPM is studied. The presentation, need for pacemaker, and cardiac intervention were noted in patients with CHB. Mode of delivery, obstetric complications, and neonatal outcomes were compared with 24 low-risk pregnancies. Data analysis was carried out using SPSS software.

Results: Syncope was presenting symptoms in seven (70%) women. Three women (30%) presented for first time during pregnancy. Out of 12 pregnancies in 10 women, eight pregnancies in six patients had a permanent pacemaker (PPM) from the start of pregnancy. Among rest four patients without a PPM, two (50%) needed pacing, one needed PPM in the second trimester, and one had a temporary pacemaker implantation (TPI) at the time of delivery. Obstetric complications and period of gestation were similar between cases and controls. The cesarean delivery rate was higher in patients with CHB, but the difference was not significant (75% vs. 37.5%, p = 0.07). None of the patients needed intensive care unit care. Mean birth weight was lower among cases (2443 ± 442 g vs. 3167 ± 434 g), but the incidence of fetal growth restriction was not different between cases and controls.

Conclusion: Pregnancy in patients without PPM can be safely managed without pacing, with good obstetric and neonatal outcomes. Backup for TPI and/or cardiac interventions should be available during labor.