Management of supraventricular tachycardia during hexoprenaline therapy for preterm labour: benefit of cardioselective beta blockade?

Cardiovascular pharmacotherapeutic considerations during pregnancy and lactation

Cardiovascular drugs are often used in pregnancy for the treatment of maternal and fetal conditions. Mothers could also require continued postpartum drug therapy. Most cardiovascular drugs taken by pregnant women can cross the placenta and therefore expose the developing embryo and fetus to their pharmacologic and teratogenic effects. These effects are influenced by the intrinsic pharmacokinetic properties of a given drug as well as by the complex physiological changes occurring during pregnancy. Many drugs are also transferred into human milk and therefore can potentially have adverse effects on the nursing infant. This 2-part article summarizes some of the available literature concerning the risks and benefits of using various cardiovascular drugs and drug classes during pregnancy and lactation. Included in the discussion are cardiac glycosides, antiarrhythmic drugs, drugs used to treat both acute and chronic hypertension, cholesterol-lowering agents, anticoagulants, thrombolytics, and antiplatelet drugs.

Supraventricular tachycardia during spinal anaesthesia for caesarean section

A woman of 40 weeks' gestation, who was apparently previously healthy, required emergency caesarean section after a failed vacuum delivery. While under spinal anaesthesia she developed a supraventricular tachycardia of unknown origin. Intravenous verapamil resulted in a conversion to sinus rhythm. Further investigations confirmed Wolff-Parkinson-White syndrome, for which she required ablation therapy. Appropriate methods of cardioversion in this clinical setting are discussed.