Department of Obstetrics, Maternal Medicine Service, St George's Hospital, Blackshaw Road, London, UK.
Department of Cardiology, University Hospitals Coventry and Warwickshire, Coventry, UK.
BJOG. 2023 Sep;130(10):1269-1274. doi: 10.1111/1471-0528.17457. Epub 2023 Apr 11.
Direct current cardioversion (DCCV) in pregnancy is rarely required and typically only documented in single case reports or case series. A recent UK confidential enquiry reported on several maternal deaths where appropriate DCCV appeared to have been withheld.
Retrospective cohort study.
Seventeen UK and Ireland specialist maternity centres.
Twenty-seven pregnant women requiring DCCV in pregnancy.
Maternal and fetal outcomes following DCCV.
Twenty-seven women had a total of 29 DCCVs in pregnancy. Of these, 19 (70%) initial presentations were to Emergency Departments and eight (30%) to maternity settings. There were no maternal deaths. Seventeen of the women (63%) had a prior history of heart disease. Median gestation at DCCV was 28 weeks, median gestation at delivery was 35 weeks, with a live birth in all cases. The abnormal heart rhythms documented at the first cardioversion were atrial fibrillation in 12/27 (44%) cases, atrial flutter in 8/27 (30%), supraventricular tachycardia in 5/27 (19%) and atrial tachycardia in 2/27 (7%). Fetal monitoring was undertaken following DCCV on 14/29 (48%) occasions (10 of 19 (53%) at ≥26 weeks) and on 2/29 (7%) occasions, urgent delivery was required post DCCV.
Direct current cardioversion in pregnancy is rarely required but should be undertaken when clinically indicated according to standard algorithms to optimise maternal wellbeing. Once the woman is stable post DCCV, gestation-relevant fetal monitoring should be undertaken. Maternity units should develop multidisciplinary processes to ensure pregnant women receive the same standard of care as their non-pregnant counterparts.
直流电复律（DCCV）在妊娠中很少需要，通常仅在单个病例报告或病例系列中记录。最近英国的一项机密调查报告了几起产妇死亡事件，其中似乎有适当的 DCCV 被拒绝。
回顾性队列研究。
英国和爱尔兰的 17 个专业妇产中心。
27 名在妊娠中需要 DCCV 的孕妇。
DCCV 后母婴结局。
27 名妇女共进行了 29 次妊娠中的 DCCV。其中，19 例（70%）初始表现为急诊科就诊，8 例（30%）为妇产科就诊。无产妇死亡。17 名妇女（63%）有先前的心脏病史。DCCV 时的中位孕龄为 28 周，分娩时的中位孕龄为 35 周，所有病例均为活产。首次复律时记录的异常心律为 27 例中的 12 例（44%）心房颤动、8 例（30%）心房扑动、5 例（19%）室上性心动过速和 2 例（7%）房性心动过速。在 29 次 DCCV 中有 14 次（48%）进行了胎儿监测（19 次中的 10 次[53%]在≥26 周时），有 2 次（7%）在 DCCV 后需要紧急分娩。
妊娠中直流电复律很少需要，但应根据标准算法在临床需要时进行，以优化母婴健康。DCCV 后，一旦患者稳定，应进行与妊娠相关的胎儿监测。妇产科应制定多学科流程，以确保孕妇得到与非孕妇相同的护理标准。
