Recurrent Episodes of New-Onset Supraventricular Tachycardia in Severe Early-Onset Pre-eclampsia and Fetal Growth Restriction: A Report of a Complex Cardio-Obstetric Case

Abstract

Supraventricular tachycardia (SVT) is one of the commonly reported sustained arrhythmias in pregnancy. The rapid progression from early-onset fetal growth restriction (FGR) to severe pre-eclampsia is a well-recognised manifestation of placental dysfunction. The coexistence of both leads to significant maternal and fetal morbidity, adding substantial complexity to management. We present the case of a 27-year-old primigravida of Caucasian origin with an otherwise uncomplicated pregnancy who attended at 28 weeks' gestation solely because of a maternal concern that her baby appeared small. This seemingly routine presentation initiated a rapid sequence of events, culminating in the diagnosis of severe early-onset FGR, fulminant pre-eclampsia and recurrent new-onset SVT. Her clinical course was characterised by simultaneous maternal and fetal deterioration, creating significant management challenges in the context of severe hypertension, placental dysfunction and fetal compromise. Following delivery by caesarean section for worsening maternal and fetal status, she required intensive care admission, repeated administration of adenosine and ongoing multidisciplinary management to achieve cardiovascular stabilisation. Recurrent episodes of SVT persisted into the postpartum period, necessitating further specialist input and escalation to the regional Maternal Medicine Network. She was subsequently stabilised on bisoprolol and enalapril, with no further documented SVT episodes before discharge. This case highlights the rare coexistence of severe placental disease and recurrent episodes of new-onset SVT in pregnancy, and the complexities associated with balancing maternal cardiovascular stability against fetal well-being. It underscores the importance of early multidisciplinary involvement, including obstetric, cardiology, anaesthetic, critical care and maternal medicine teams. Furthermore, it demonstrates that delivery is not always the definitive solution to complex obstetric pathology, as significant maternal cardiovascular morbidity may persist beyond the immediate postpartum period. Finally, the case emphasises the importance of listening to maternal concerns regarding fetal well-being, even when initial assessments are reassuring, and recognising the need for ongoing psychological support and counselling following traumatic pregnancy complications.