Unexpected heart block in the delivery room: the utility of ECG monitoring

A woman, who had not received adequate prenatal care, arrived in labour at 38 weeks’ gestation and rapidly delivered a 3 kg baby boy via repeat caesarean section. At the time of arrival, the head was engaged in the pelvis, and a vaginal hand was used during the delivery. Fetal heart rate patterns were unknown prior to delivery, due to scant fetal monitoring. She reported a history of depression and tobacco use during pregnancy. Soon after birth, at about 3 minutes, the advanced neonatal resuscitation team was called. The infant was floppy and without heart beats detectable by pulse oximetry, despite initial standard neonatal resuscitation efforts. He was receiving …