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We report labour pain management in a full-term pregnant patient with Congenital Complete Heart Block. She delivered uneventfully under routine monitoring with facilities for pacing at hand. She previously had an uneventful normal delivery and a D&E, both outside our hospital. Only findings were a low heart rate of 45-50 beats per minute. She never had syncopal attacks. She had a good effort tolerance on ETT. Her ejection fraction was 60% on Echocardiogram. She was given a single shot low dose spinal with fentanyl followed by epidural insertion. She successfully delivered through mid-cavity forceps in about 2.5 hours. The only problem encountered was a transient bradycardia of 40 per minute with a systolic blood pressure of 70 mmHg, which settled with ephedrine. Pace maker insertion is recommended early in case the patient is symptomatic or has a prolonged Q-T interval or left atrial enlargement on ECG. Regional anaesthesia is recommended to prevent valsalva induced bradycardia or cardiac arrest during expulsive efforts by the patient.


Journal of Pakistan Medical Association