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546
Prenatal
Ultrasonic
Terry
Silver,1
Jeffrey
Spooner,2
and
M.
Eric
W.
Fetal
heart
Doppler weeks
of Congenital
can
M.
be
demonstrated
ultrasonography. menstrual period,
laboratories
nations The
do
performing
not
potential
routinely
readily
by
Beginning at it is often possible
clinical
obstetrical document
value
cardiac activity and rate of congenital heart block.
Block
Cohen3
Case
20 to
ultrasound fetal
of routinely
is illustrated
heart
An
woman
to estimate
to determine
obesity
and
raphy
was
on
and
an obstetric
Gestational
examination
menstrual
fetus
for age.
physical
a single
placenta,
referred
gestational
because
revealed
anterior
pulsations.
following
1 8-year-old
cult
exami-
documenting by the
Report
examination
obtain a time-motion echocardiogram of the fetus [1 ]. This provides an accurate recording of fetal heart rate, an extremely important measure of fetal well-being. Nonetheless, some
Heart
D. Wicks,1 Stephen
movements
or real-time from the last
Detection
dates
were
in vertex
a gestational
because
age
uncertain.
presentation of 35
weeks.
ultrasound age
was
diffi-
of marked Ultrasonog-
(fig. Fetal
1 A), an heart
motion documented by Doppler was abnormally slow, about 60 beats/mm. Maternal pulse taken manually as the Doppler examination was performed yielded a rate of 95/mm. The M-mode display of fetal cardiac motion documented a regular heart rate of 60
fetal case
B
A
Fig cardiac
1 -A, activity
Received
.,
AJR
Sagittal Fetal January
B scan. Anterior placenta heart rate of 60 beats/mm. after
of Michigan
Medical
Center.
Ann
Arbor,
Ml 48109.
Department
of Pediatrics,
University
of Michigan
Medical
Center,
Ann
Arbor,
Ml 48109.
Department
of Obstetrics
and
1979;
0361
-803x/79/1333-0546
P
=
placenta.
B, M-mode
(time-motion)
1 , 1979.
accepted
University
(arrow).
is 1 sec.
University
September
May
heart
of Radiology,
Gynecology,
revision
Fetal
Department
133:546-547,
3, 1 979;
and fetus in vertex presentation. Interval between black arrows
of Michigan
Medical
$00.00;
Center,
© American
Ann
Address
reprint
requests
Arbor,
Ml 48109.
Roentgen
Ray
Society
to T. M. Silver.
display
of fetal
AJR:133,
September
CASE
1979
547
REPORTS
In our were
case,
both
bradycardia.
,
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-
.-.-
.:
-
.
c;’-
-
,
.
,=:..‘
-
:
‘#{231};--L1’
‘-i-”
-
.I’
.,
“S’:
than
of a pulsed
.
Fig.
2.-Normal
wall;
aaw
echocardiogram anterior aortic
=
wall;
aortic valve leaflets; sept = = left atrial wall; ch = chordae penicardial-epicardial interface.
The
(age 2 hr), except for heart rate. rvaw = right ventricular anterior
septum; paw tendineae;
posterior aortic end = endocardium; =
cw = wall;
wall;
law p
=
beats/mm (fig. 1 B). On the basis of the very slow fetal heart rate before labor, a congenital heart block was postulated. The patient had an otherwise benign antepartum course, but the fetal heart rate remained 60-70 beats/mm. With
a pediatric vaginally
of 7 at 1 mm
cardiologist delivered
and
in attendance,
a 3,470
8 at 5 mm.
The
g male infant
1 month
infant
was
with
later
Apgar
asymptomatic
the
scores and
in no
distress. Other than a regular bradycardia, physical examination was normal. Electrocardiography showed a 2:1 atnioventricular block. An echocardiogram was normal except for the heart rate (fig. 2). The child was discharged on the tenth day of life with a heart rate of 76 beats/mm after observation had revealed no signs of congestive mal
heart
growth,
physical
failure.
no
Initial
signs
examination,
of
follow-up
examinations
congestive
except
for
heart
the
showed
failure,
obstetrical gist
of the
profound cardiovascular
cases
is at least
congenital births), have
(often
and
nor-
a normal
and
29%
complete it is significantly
connective
intrauterine)
and
of an
permanent
tissue
[2]. Although heart
block higher
disease
heart
mortality
the overall is low in fetuses
[3].
(1 per
fetal
the
slow
difficult Since
than
of
fetal heart can also de-
is more
sharper
fetal
diagnosis
the
to
peaks conven-
appears more suitrate and its variations
20,000
of live
mothers
examination
in such
modified
The fetus was followed intervals.
A pediatric
present
at
our
was classified in the high the
cardiolo-
delivery.
In this
placement heart
ultrasound
as risk
was motion
examination.
conas
a
If an
rate is detected by real-time or Doppler, should be obtained for documentation The addition
of an M-mode
activity lengthens than a few minutes.
electrocardiogram
monitor
cases
recording
the ultrasound examiPatients so identified
in a high risk obstetrical clinic should be present at delivery. A
can be of value as well [5].
as an
intrapartum
REFERENCES
3.
.
F: Echocardiography of the fetal and newborn 7 : 1 52-1 58, 1972 Micha#{232}lsson M, Engle MA: Congenital complete heart
Winsberg
study
CM, Mantakas block
natural
in
ME, Tingelstad
newborns
of
Circulation
56:82-90,
KC, Meire
HB: Fetal
ultrasound.
Clin
by pulsed
Sokol RJ, Hutchison Vasquez H: Congenital intrauterine 1117,
of the
history.
Cardiovasc
block: Clin
4:
1972
disease. 4. Dewbury 5.
heart.
Radiol
McCue heart
such
incidence
was
should be followed closely and a pediatric cardiologist
1
failure in
whose
are
obstetric
record.
fetal heart by no more
Invest
congestive Neonatal
rate
ultrasound
at frequent
consulted
part
of the nation
bradycardia.
with a very low ventricular rate may be a neonatal emergency,
collapse.
correct
or M-mode.
ultrasound of heart
management. the patient
clinic
was
85-101,
and
exact
Doppler
signal
abnormal fetal heart an M-mode recording
Discussion
with
to the
signal, pulsed measurement
an international
heart block beats/minute)
recording
case, emergency cardiac pacemaker sidered unnecessary. We recommend documenting fetal
2.
Congenital (less than 55
the
either
ultrasound
results
routine
patient
prenatally
but with
patient’s prenatal ‘ , high risk, ‘ ‘ and chest av =
ultrasonography
and
[4].
--
I;
led
a bradycardia,
determine
)sept.
-‘-
M-mode
heart block, based on the very to labor. Real-time ultrasonography
tional Doppler able for precise
‘
:
‘.
tect
,,,
and
in detecting
This
congenital rate prior
rvaw
Doppler
complementary
1974
fetal
JB, Ruddy
mothers
with
S: Congenital
connective
tissue
1977
valve movement recording 29: 1 -4, 1978 P, Knouskop RW, Brown EG, Reed G, complete heart block diagnosed during
monitoring.
mitral
Radiol
Am
J Obstet
Gynecol
1 20:
1 1 15-