Several protocols can be found in the literature, with different medications best preferred.
Great Ravi !
Thx for the sharp answer and for sending the references you quoted.
Actually the case that I was referring to was a 31 GA.
My personal impression is that in front of a fetal SVT we should always try a pharmacologic cardioversion at first.
Some ObGyn I met, skilled in fetal cardiology, told me that they have been shifting from digoxin to sotalol as the first line medication.
What do you think about giving the fetus 72 hours of full therapy before deciding to deliver if the SVT did not stop?
Thank you very much again
Claudio
As someone who has managed these types of patients for 25 years, digoxin remains our first therapy, loaded mom, have not actually done fetal IM injection. We do this in part to mitigate some of the negative inotropic effect of all of the other options in anit-arrythmia therapy. In hydropic but premature fetus, we will quickly add flecainide. We have not actually delivered any fetus prematurely (i.e. 15 years with this strategy. A few babies have been inadequately controlled on this combination and amio has been our 3rd line agent, though sotalol has also had more recent reports of efficacy (it has been more than 10 years since we have had to go beyond second line).
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