Hepatic venous Doppler in the evaluation of fetal extrasystole.

OBJECTIVE: To evaluate the hepatic venous Doppler technique in the diagnosis of premature heart beats in prenatals. Furthermore, to estimate the prevalence and persistency of atrial and ventricular extra beats throughout pregnancy and delivery, and explore the coexistence of congenital heart disease. METHODS: Retrospective study of 256 singleton pregnancies on out-patient attendance due to fetal extra beats. Hepatic venous Doppler and detailed fetal echocardiography were performed. Fetal heart rate patterns during labor and neonatal conditions were collected. Congenital heart malformations and the frequency and persistence of fetal extrasystole were noted. RESULTS: 228 (89%) showed signs of supraventricular extrasystole (SVES) and 19 (11%) had ventricular extrasystole (VES). One fetus with SVES developed atrial flutter during pregnancy and another supraventricular tachycardia postnatally. SVES persisted in 28 fetuses until labor and delivery (12.3%) and in 6 with VES (21.4%). In 31 of 34 having extra beats during labor and delivery, the conduction pattern normalized within three days (91.2%).Five neonates were referred for evaluation by a pediatric cardiologist. Two cases had congenital heart disease. Extra beats persisted until labor and delivery more frequently in male fetuses (p<0.0001). CONCLUSIONS: Hepatic venous Doppler can differentiate between SVES and VES. Although more uncommon, VES tends to persist throughout pregnancy more often than SVES. In spite of this, the results strongly support a benign development with only two cases developing tachycardia and two (0.78%) having a coexisting congenital heart malformation. Copyright (c) 2010 ISUOG. Published by John Wiley & Sons, Ltd.