Neela asked 8 months ago
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I am 23 weeks pregnant and just found out that my baby has an irregular heartbeat. My doctor has scheduled another test. What is your experience with abnormal heartbeats in a fetus? Does it usually correct itself before the baby is born?



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1 Answers
Helen George - midwifeHelen George - midwife Staff answered 8 months ago
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The vast majority of time, an irregular heartbeat in a fetus disappears before or right after birth. Nevertheless, when a fetus has a potential abnormal beat, further tests will help determine possible causes and rule out other problems.
Generally, the fetal heartbeat should be regular and within a range of 120 to 160 beats per minute. At each prenatal visit your doctor will listen to the fetal heartbeat and count it. It may be abnormal if it’s too fast, too slow, or if the rhythm is irregular. Sometimes both the rate and the rhythm are out of normal range. It’s easy to hear if it’s irregular, but it’s often difficult to figure out why.
If the fetal heart rate is below 110 beats per minute, that’s called bradycardia; if it’s 161 to 180, it’s mild tachycardia; and if it’s above 180 beats per minute, it’s severe tachycardia. A rate that’s persistently too high or too low may be a sign of increased fetal stress.
Causes of fetal bradycardia include, but aren’t limited to, umbilical cord compression, fetal head compression, heart abnormalities, certain drugs, or low temperature or oxygen levels (also called hypoxia). Reasons for fetal tachycardia include certain drugs; maternal fever, infection or hyperthyroidism (increased amount of thyroid hormone); or fetal anemia, heart failure, heart abnormalities, or hypoxia.
The medical term for an irregular heart rhythm is cardiac arrhythmia, and the condition can occur with or without bradycardia or tachycardia. Fetal cardiac arrhythmia is actually not rare, and most of the time it’s a benign condition without consequences to the fetus.
More than 85% of fetuses with an irregular heartbeat have a generally benign condition called extrasystole, which is the medical term for a skipped beat.
As long as extrasystole doesn’t occur too often — even as many as several skipped beats per minute — and there’s no congenital heart disease, it’s not a big deal. Skipped beats usually disappear within several days and are often not present after delivery. But if it happens more often, and if the heart rate is also too fast or too slow, additional testing is indicated.
When your doctor hears a fetal arrhythmia, she will order further tests, because irregular heartbeats are sometimes associated with serious heart conditions — such as congenital heart disease or other malformations — that should be diagnosed as early as possible. This is usually done with a specialized ultrasound called a fetal echocardiogram, which is similar to a regular ultrasound except the fetal heart is more thoroughly evaluated.
After skipped beats, the two most frequent and serious irregular fetal arrhythmias are supraventricular tachycardia and complete fetal heart block. Supraventricular tachycardia is associated with a high heart rate, and a heart block occurs when the two parts of the heart — the atria and the ventricles — beat separately.
If a fetal heart beat abnormality is found, your doctor will do a medical history and probably order additional blood tests. When the fetus has a complete heart block, for example, there is an increased risk that the mother carries certain antibodies called anti-Ro/anti-La, which cross the placenta and are directed against the fetal heart. With a congenital heart condition, there is also an increased risk that the fetus has a chromosomal abnormality or other abnormality, and your doctor might suggest an amniocentesis.
You may be at increased risk of carrying a fetus with congenital heart disease if:
You or another child or family member have congenital heart disease
Your fetus hasn’t grown enough (intrauterine growth restriction, IUGR)
Your amniotic fluid level has decreased
You’re carrying twins
You come down with an infection or are exposed to alcohol or teratogens (substances, such as drugs, that may cause birth defects) during pregnancy
You had diabetes prior to pregnancy
You have a connective tissue disease such as lupus
If your doctor discovers what seems to be benign extrasystole in your fetus, you may want to stay away from caffeine products during your pregnancy to make sure they don’t affect the fetal heartbeat.
Treating more serious fetal cardiac arrhythmias is one of the more complicated disciplines of cardiology. It’s difficult, and often different medications need to be tried until the fetus’s heart beat returns to normal. Your doctor will most likely do regular evaluations for signs of heart failure, such as an accumulation of water in the fetus. Early delivery of the baby is often indicated when the arrhythmia doesn’t get better or fluid accumulates — both sign that the fetus’s heart may not strong enough.



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