Table 1.
Postural orthostatic tachycardia syndrome (POTS) complicating pregnancy: previous cases reported in the literature
| Reference | Number of cases | Maternal age (years) | Parity | Severity of POTS | Medications prior to pregnancy | Medications during pregnancy | Duration of POTS (years) | Course of POTS in pregnancy | Comorbidity | Antenatal complications | Mode of delivery | Labour analgesia | Neonatal outcomes | Postnatal improvement | ||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Glatter et al. 7 | 2 | 26 | – | Severe | Midodrine | Midodrine | 3 | Deterioration >24 weeks | – | Hyperemesis | Elective caesarean section | Epidural | 3.2 kg (both) | Symptoms improved, drug dosage↓ | ||
| 24 | – | Severe | Midodrine and β-blocker | None | 6 | |||||||||||
| Corbett et al.9 | 1 | 30 | N | Hyperadrenergic form | β-Blocker | ↑ Dose of β-blocker | 3 | Worsened | Mitral valve prolapse with regurgitation | – | Emergency caesarean section | Epidural | 3.65 kg Apgar – 1 and 5, minute – 8, 9 | Improved | ||
| McEvoy et al.10 | 1 | 18 | P | – | Fludrocortisones and β-blocker | Unchanged | – | Unchanged | – | Pregnancy-induced hypertension | Forceps | Epidural | Apgar – 1 and 5 minute – 6, 8 | – | ||
| Kodakkatil and Das6 | 1 | 21 | N | Grade III POTS | None | None | 5 | Unchanged | – | Threatened preterm labour | Vaginal | Epidural | – | – | ||
| Kanjwal et al.8 | 22 | 30±7 | – | 21 – partial dysautonomic form; 1 – hyperdrenergic form | – | β-blocker (18%), midodrine (31%), SSRI's (31%), fludrocortisone (13%), Combination (40%), none (18%) | – | Unchanged – 3 (13%), improved –12 (55%), worsened – 7(31%) | Migraine 36%, joint hypermobility syndrome 9%, factor V deficiency 9% | Hyperemesis – 1 (4.5%), complete heart block – 1 (4.5%) | Vaginal – 18 (82%), caesarean – 4 (18%) | – | 1 – atrial septal defect, 1 – ventricular septal defect, 1 – ventricular septal defect | Stable – 15 (69%), worse – 7 (13%) | ||
| Jones and Ng11 | 1 | 34 | N | – | – | – | 7 | Worsened | Ehlers–Danlos syndrome type III | – | Elective caesarean section | Epidural+ spinal | Apgar score – 1and 5, minute – 9, 10 | Improved | ||
| Powless et al.5 | 7 (9 pregnancies) | – | N and P | – | 4(6) – β-blockers, 1 – pyridostigmine and Fludrocortisones, 2 – not on drugs | 1(2) – drugs unchanged, 2(3) – ↑dose of β-blocker, 1 – addition of drugs, 2 – not on drugs | – | 4(5) – exacerbation | – | 1 – oligohydramnios, 1 – chronic placental abruption, 1 – PPROM*, preterm labour, 1 – gestational hypertension | Vaginal – 7, caesarean – 2 | 5 – epidural (vaginal delivery) | 3.15 kg (mean) | – | ||
| Kimpinski et al.2 | 51 (116 pregnancies) | P – 33.6 ± 8.4, N –29.6 ± 10.1 | N and P | – | – | – | P – 3.7 ± 2.6, N – 2.1 ± 2.2 | P (51) | N (61) | Migraine (P – 24%, N – 26%) | Miscarriage, placenta previa, placental abruption, malpresentation, peripartum hysterectomy | – | – | 2.995 kg± 0.834 kg, Apgar score 1 minute – 8.2 ± 0.8, 5 minutes – 9.2 ± 0.4 | Improved | |
| Static | 84% | 88% | ||||||||||||||
| Progressive | 8% | 0 | ||||||||||||||
| Improved | 4% | 6% | ||||||||||||||
| Relapse–remitting | 2% | 5% | ||||||||||||||
| Unknown | 2% | 0 | ||||||||||||||
| Kimpinski et al.12 | 1 | 26 | P | – | – | – | Diagnosed 3 weeks postpartum | Peripartum cardiomyopathy | – | Elective caesarean section | – | – | – | |||
P, parous; N, nulliparous; SSRI's, selective serotonin reuptake inhibitors; PPROM, preterm premature rupture of membranes