EP10.05: Postnatal follow up of successful intraperitoneal injection of amiodarone for fetal hydrops with tachyarrhythmia

Fleicanide is the drug of choice in treating tachyarrhythmia in fetal hydrops yet it is unavailable in Indonesia. One of the alternative is using amiodarone. We evaluated the treatment of tachyarrhythmia in fetal hydrops using intraperitoneal injection of amiodarone. This is a case series of 5 hydropic fetuses with tachyarrhythmia at Harapan Kita Women and Children Hospital as a tertiary fetal medicine centre in Indonesia during 2020-2023. We used Voluson E10 (GE medical systems, Austria) with anatomic M-mode. SVC or aorta Doppler was performed to determine the tachycardia (short or long VA). Amiodarone injection was done under US guidance with amniocentesis needle. Maternal condition was monitored with electrolytes and ECG. Follow up was done before and after birth. All babies were discharged with anti-arrhythmic drugs. This protocol was approved by Ethics Committee. There were 5 cases of tachyarrhythmia in hydrops, 4 with SVT and 1 with atrial flutter. In cumulative, it took 2-8 days to reach normal heart rate. Intraperitoneal injection of 2.5-5mg amiodarone was performed followed by 800-1600mg maintenance dose. No side effects were reported. All fetuses showed normal heart rate in postnatal ECG with 1 case requiring oral propranolol due to neonatal hyperthyroidism. Our protocol was aggressive using intraperitoneal amiodaron with 100% survival and success rate and no reported side effect, unlike intraumbilical route. This study is limited in its number of cases and design. Longer follow-up is warranted for heart and neurologic evaluation. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.