PP-033 The Atrioventricular complete heart block diagnosed on the preoperative routine test for caesarian section

The management of women presenting with with complete heart block  during pregnancy remains very challenging. Untill now,  there is not an established consensus for the most appropriate anaesthetic technique for caesarean section in women with complete atrioventricular block.

On our case, the atrioventricular complete heart block was  diagnosed on the preoperative routine test for Caesarian Section due  to cephalo-pelvic disproportion. The  patient had  no rregular antenatal check ups at a local hospital. Her parents reported rare episodes of syncope during childhood and adolescence and one more episode two year before. During pregnancy she did not report any  sincope  episode except from being tired .

For obstetric reasons caesarean section was performed successfully under spinal anaesthesia with continuous monitorization during intraoperative time without a pacemaker .Even though the patient reacted well during administration of atropine a temporary pacemaker was found to be in case we would need it. A healthy  baby boy of 3350 gram was delivered. During postpartum period the patient did not have any complains or syncope episodes. It was strongly recommended to her a regular follow up to cardiology department.

As suggested by our case, asymptomatic atrioventricular complete heart block in pregnancy can  be managed successfully  without pacemaker. However, careful monitoring,  is necessity by the pregnancy heart team with  a cardiologist, anaesthetist and obstetrician, with experience in the management of high risk pregnancies. Management of the risk for cardiovascular and obstetrical complications is difficult in pregnant  women with complete heart block. Asymptomatic complete heart block in late pregnancy should be managed without pacemaker by the pregnancy heart  team with  a cardiologist, anaesthetist and obstetrician, with experience in the management of high risk pregnancies.