Anesthetic Management for Cesarean Section in a Patient Receiving Transplacental Treatment of Fetal Tachyarrhythmia: a Case Report

Background: Although rare, long-lasting fetal tachyarrhythmia often leads to fetal heart failure and hydrops. Some mothers receive transplacental treatment of fetal tachyarrhythmia (TTFT), which can potentially worsen maternal hypotension and bradycardia. Moreover, the use of rescue cardiovascular agents intraoperatively can worsen fetal tachycardia. However, reports of the anesthetic management of patients receiving TTFT are rare.

Case Presentation: A 31-year-old woman who was receiving digoxin and sotalol for TTFT underwent planned elective cesarean section. The fetus had hypoplastic left heart syndrome, hydrops, and tachycardia. We used combined spinal-epidural anesthesia with a reduced dose of local anesthetic. We also employed a non-invasive continuous hemodynamic monitoring system. The mother's systolic blood pressure remained at ≥ 90% of the baseline value; intraoperative administration of rescue cardiovascular agents was not required.

Conclusions: We successfully anesthetized a woman for cesarean section, who was receiving TTFT for fetal tachyarrhythmia, using combined spinal-epidural anesthesia and non-invasive continuous hemodynamic monitoring.