Letter to the Editor - Successful Pregnancy Outcome in a Patient with Complete Heart Block

We recently had a patient aged 30 years who was 7 months' pregnant with complaints of labour pains. There was no history of leaking or bleeding per vaginum and she had no symptoms suggestive of heart disease. On examination her pulse rate was 46 / minute and regular, BP was 110/60mm/Hg. Mild pallor was present. There was no cyanosis or oedema, jugular venous pressure was not raised. Examination of cardio-respiratory system revealed no abnormality. On abdominal examination there was a singleton foetus in cephalic presentation; uterine height corresponded to 30 weeks of gestation. There were mild uterine contractions, foetal heart rate was 140 beats/minute. Her haemoglobin was 9g%, urine analysis was normal. ECG showed complete heart block. Echocardiography was normal. Investigations were done to rule out possible underlying causes of heart block - Anti-Nuclear antibody was negative (which ruled out SLE) and serum TSH was 2.8ng/ml (which ruled out thyroid disorders). She was put on temporary pacemaker. Her labour pains subsided without any medication after 6 hours and the pacemaker was removed after 48 hours. Permanent pacemaker was advised but patient could not afford it at that time.