Summary
DOI: 10.1373/clinchem.2013.212035
As part of routine prenatal care, the obstetrician of a 25-year-old gravida 1, para 0 woman performed fetal heart-rate monitoring at 22 weeks gestational age. The fetal heart rate was 90 bpm, below the expected range of 120–160 bpm. This finding prompted a subsequent fetal ultrasound and echocardiogram.
Student Discussion
Student Discussion Document (pdf)
Michael A. DiMaio1* and James D. Faix1
1Department of Pathology, Stanford University Medical Center, Stanford, CA.
*Address correspondence to this author at: Department of Pathology, Stanford University Medical Center, 300 Pasteur Drive, Lane 235 MC 5324, Stanford, CA 94305-5324. Fax 650-725-6902; e-mail [email protected]
Case Description
As part of routine prenatal care, the obstetrician of a 25-year-old gravida 1, para 0 woman performed fetal heart-rate monitoring at 22 weeks gestational age. The fetal heart rate was 90 bpm, below the expected range of 120–160 bpm. This finding prompted a subsequent fetal ultrasound and echocardiogram.
The ultrasound exam showed no evidence of hydrops. Cardiac anatomy was normal, with 4 appropriately sized chambers, no valvular defects, and no abnormal communications between the right and left circulations. However, the electrocardiogram demonstrated a 2:1 atrioventricular heart block (1 ventricular beat for every 2 atrial beats). Previously, a first-trimester screen to detect fetal aneuploidy had been performed and the results were normal. Results of serologic testing for hepatitis B, varicella, and rubella viruses were consistent with maternal immunity. Results of syphilis and HIV antibody tests were also negative. The expectant mother had no significant medical history, was taking no medications, and had no history or symptoms of autoimmune disease.
Questions to Consider
- What conditions can cause an abnormally slow fetal heart rate?
- What conditions can cause congenital heart block?
- What additional testing should be performed?
Final Publication and Comments
The final published version with discussion and comments from the experts appears
in the March 2014 issue of Clinical Chemistry, approximately 3-4 weeks after the Student Discussion is posted.
Educational Centers
If you are associated with an educational center and would like to receive the cases and
questions 3-4 weeks in advance of publication, please email [email protected].
AACC is pleased to allow free reproduction and distribution of this Clinical Case
Study for personal or classroom discussion use. When photocopying, please make sure
the DOI and copyright notice appear on each copy.
DOI: 10.1373/clinchem.2013.212035
Copyright © 2014 American Association for Clinical Chemistry