CLINICAL SIGNIFICANCE AND DIAGNOSIS OF FETAL HEART RHYTHM DISORDERS
DOI:
https://doi.org/10.11603/24116-4944.2025.2.15801Keywords:
fetal heart rhythm disorders and fetal arrhythmias, risk factors, perinatal outcomes, fetal growth restriction, non-immune fetal hydropsAbstract
The aim of the study – to assess the spectrum of fetal heart rhythm disorders with determination of the possible causes of their development and consequences for the newborn, as well as the diagnostic value of assessing functional disorders in the «mother – placenta – fetus» system.
Materials and Мethods. Two groups of patients were examined, where the assessment of medical documentation, labor histories, sonographic reports, and newborn records was taken as the basis: 96 pregnant women with a singleton pregnancy and heart rhythm disorders formed the main group, and 40 patients with a physiological course of pregnancy and a satisfactory intrauterine fetal condition formed the comparison group.
Results and Discussion. Structure of fetal dysrhythmia variants: 27 cases (28.1 %) were tachyarrhythmias, bradyarrhythmias, or unstable extrasystoles; stable heart rhythm disorder (more than 10 minutes) of the bradycardia type was noted in 41 (42.7 %) observations; in 28 (29.2 %) cases tachycardia was verified. Risk factors for the development of fetal arrhythmias are few; a low associative dependence with maternal somatic pathology, age and parity of pregnancy should be noted; however, acute viral infection during pregnancy (49.0 %; OR=3.30; χ2 – 7.10; p<0.01), immune-inflammatory (21.9 %; OR=10.92; χ2 – 6.45; p<0.01) and chronic inflammatory maternal diseases (44.8 %; OR=3.82; χ2 – 7.91; p<0.01), herpesvirus infection (25.0 %; OR=13.0; χ2 – 8.09; p<0.01) are the leading trigger factors for arrhythmia development. In the main group, in most cases the pregnancy resulted in the birth of a live newborn (90.6 %); in 24.1 % an elective delivery decision was made; in 9.4 % antenatal fetal death was recorded; early neonatal death – in 12.6 %. According to the Apgar score <6 points, 17 newborns (19.5 %) were born; 39.1 % were transferred to the intensive care unit; newborn weight <10th percentile was noted in 29.9 %, and <3rd percentile in 12.6 %.
Conclusions. Variants of fetal arrhythmias combined with intrauterine infection, fetal hydrops, and fetal growth restriction carry the greatest burden regarding adverse perinatal outcomes. In case of early arrhythmia manifestation (before 28 weeks of gestation) an extremely high risk of rapid development of circulatory failure and antenatal fetal death was noted.
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