Para-number of times given birth Term/Premie/Abortions/Alive Gravid=# of times pregnant Lab Tests in Pregnant Women
Anti-Arrhythmics in Pregnancy
from Clicem Treatment of arrhythmia in pregnancy is challenging and often problematic. There are no large cohort or randomized trials regarding the use of anti-arrhythmics in pregnancy. Treatment is guided by type of arrhythmia and the presence of hemodynamic compromise. Use of any medication in this setting should be done with foresight, caution, and a full understanding of the risks and benefits. Vagal maneuvers, if indicated, should be attempted first. Generally Safe DC Cardioversion is well-tolerated in pregnant patients. Adenosine has not been shown to have an adverse maternal or fetal effect. Quinidine has been used safely in pregnancy for over 50 years. Procainamide has no known teratogenic effects, however, its chronic use is not recommended. Use with Caution Beta blockers have been used in pregnancy to treat hypertension and thyrotoxicosis, but the safety of these agents is controversial due to isolated reports of premature labor, growth retardation, bradycardia, neonatal apnea, and hypoglycemia. Calcium channel blockers are effective to control rate or treat atrial arrhythmias, but may induce maternal hypotension leading to decreased placental perfusion. Amiodarone should be reserved for arrhythmias that are not responding to agents with known safety. Amiodarone is highly protein and lipid bound which results in large body stores and prolonged half-life. Each tablet contains iodine which can lead to hypo or hyperthyroidism in the
mother or fetus. There have been reports of fetal bradycardia, fetal QT prolongation, premature labor, and low birth weight. — Amy Archer, MD FACEP References: Kron J, Conti JB. Arrhythmias in the pregnant patient: current concepts in evaluation and management. J Interv Card Electrophysiol 2007;19:95. Podolsky SM, Varon J. Adenosine use during pregnancy. Ann Emerg Med 1991; 20:1027. Rubin, PC. Beta-blockers in pregnancy. N Engl J Med 1981;305:1323. Byerly W, Hartmann A, Tannenbaum A. Verapamil in the treatment of maternal paroxysmal supraventricular tachycardia. Ann Emerg Med 1991;20:552. Widerhorn J, Bhandari AK, Bughi S, et al. Fetal and neonatal adverse effects profile of amiodarone treatment during pregnancy. Am Heart J 1991;122:1162. Page, RL. Treatment of arrhythmias during pregnancy. Am Heart J 1995;130:871. | | |