DIAGNOSTIC AND PERINATAL MANAGEMENT OF FETAL EXTRASYSTOLE

Fifty fetuses referred to the Polish Mother's Memorial Hospital for fe tal echocardiography between January 1, 1991 and June 1, 1995 were eva luated. The mean fetal gestational age at the time of diagnosis of arr hythmia was 34.1 weeks, and the mean gestational age at the time of de livery was 38.7 weeks. Checkup echocardiographic examinations were per formed every 10-14 days, for a mean 2.4 studies per fetus. In most cas es (48/50, 96%), premature atrial contractions were present during the first echocardiography examination. The fetal heart study was normal in 30 cases; in 7 (14%) there was tricuspid valve regurgitation, in 7 (14%) an atrial septal aneurysm, in 4 congenital heart defects, in 1 m yocardial hypertrophy, and in 1 disproportion in the four-chamber view . Of the 50 fetuses, 43 underwent regular echocardiographic monitoring alone; in 7 cases, based on the presence of additional echocardiograp hic findings, pharmacotherapy was applied (digoxin, verapamil, or both ). Three neonates died after delivery owing to malformations in two ca ses (one critical aortic stenosis, one spina bifida plus hygroma colli ) and due to myocarditis in one case. In six of seven newborns treated in utero, myocarditis was diagnosed after birth (including the one wi th neonatal demise). Most of the newborns were in good condition after birth, their mean Apgar score being 8.6 and the mean birth weight 325 9 g. We concluded that most extrasystoles represent an isolated anomal y, not affecting the fetal condition. Their presence should not influe nce the obstetric care and may require only echocardiographic monitori ng. In most of our cases the premature contractions subsided after bir th, although sometimes they preceded fetal supraventricular tachycardi a or appeared after congenital myocarditis.