SVT, Pregnancy, and Labor

[LoriGeorge]

I am a 30 y.o. female, preg. for my third time (15 wks).  I developed PSVT and inappropriate sinus tach during my second pregnancy. Echo was normal. My HR would go up to 170-190, and was usually brought down using vagal maneuvers. This would happen about 5-7 times a week.  Many of these episodes were accompanied by syncope, but I could not be put on beta blockers because my bp is only around 80/50 when I am preg. My OB transferred our care to the Maternal Fetal Medicine docs and I was followed by them in conjunction with an EP. The SVTs continued throughout the course of the pregnancy and the last two months before I delivered I was in constant sinus tach (110-120 bpm) in addition to the PSVT.  The MFM docs had concerns about my laboring, but allowed me to labor for 12 hours before doing a c/s.  During labor I passed out 3x, my bp was low, and my HR went up to 160.  So far this pregnancy is following a similar course and I am still under the care of the EP who put me on salt tablets since I can't take any meds b/c of my bp.

1. Do you think it's OK to labor? A vaginal delivery is important to me.

2.  Should I consider an ablation after I have the baby?  I was told to consider it, and we do want more children, but it makes me nervous to think about it.

3.  Is there anything else I can do to control the PSVT while I am pregnant besides the salt tablets and staying hydrated?

I want to also point out that I am in excellent health otherwise, have been a distance runner for years, and the PSVT is only occasional when I am not pregnant.  Thanks so much for your help!

[mammabear78]

A related discussion, SVT and breastfeeding was started.

[ann g]

I developed or was found to have SVTs during labor with my first child. It was very scary as my pulse was above 300 and I had several different types of abnormal rhythems for about 10 minutes. My husband and sister are both doctors and were very conserned about my health and what happened. I am a healthy 27 yo white female, non-smoking, non-drinker that was very active before developing problems (PIH) during my first pregnancy. I am currently 9 wks pregnant with my second child (my first is only 8 1/2 months old). This was not a planned pregnancy. My cardiologist was not very helpful with my post hospital follow-ups. I became very symptomatic 3 months after my delievery. I am very scared to have another child. I feel as though people have kept or hold back information from me about my health. I am conserned because I am still breastfeeding my son and do not take a beta blocker unless I am having an SVT that the vagal maneuvers, cartiod massage, or ice did not relieve. How safe is it for me to have another child now? Is there anything I can do to prevent or help the SVTs?

[LoriGeorge]

Thanks for your help.  I appreciate your time.
Lori

[CCF-M.D.-MJM]

Hi Lori,

These are tough, somewhat subjective questions and my answer are not meant to second guess decisions made by your primary team.  You have a very frustrationg problem that may be easily fixable when you are not pregnant.

1. Do you think it's OK to labor? A vaginal delivery is important to me.

There are two issues here.  For one, every time you push, you are likely to decrease your venous return, further drop your blood pressure and pass out again.  Two, you already had a c/s and your risk of complications from a VBAC (vaginal birth after c/s) should play in as well.  My gut tells me that you will be better off with the c/s, but there is not absolute contraindication to trying a vaginal delivery.  It is up to you and your doctors to decide what is best -- but I would advise a c/s.

2. Should I consider an ablation after I have the baby? I was told to consider it, and we do want more children, but it makes me nervous to think about it.

I would at least do an EP study to figure out if this is inappropriate ST or some form of other SVT that is fixable by ablation.  If it is fixable, you sound sufficiently symptomatic to make it worth doing.

3. Is there anything else I can do to control the PSVT while I am pregnant besides the salt tablets and staying hydrated?

I am sure this has already been done, but I would use holter and event monitors to try to catch the initiation / termination of these events.  It may help in diagnosis.  Otherwise I cannot think of anything else that may help.

Good luck!!