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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-

Prenatal ultrasonic detection of congenital heart block.

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