From the Research
A new Right Bundle Branch Block (RBBB) in a patient in active labor is a significant finding that requires immediate cardiology consultation and close monitoring, as it may indicate a serious cardiac condition requiring intervention, particularly in the context of increased mortality and morbidity associated with RBBB as shown in studies such as 1 and 2. The clinical significance of a new RBBB in a patient in active labor is multifaceted, involving potential complications such as acute myocardial ischemia, pulmonary embolism, or cardiac structural abnormalities that might complicate delivery. Management should include:
- Continuous cardiac monitoring
- Obtaining a 12-lead ECG for comparison with previous tracings
- Assessment of vital signs including oxygen saturation
- Laboratory tests such as cardiac enzymes (troponin), electrolytes, and arterial blood gases if hypoxemia is suspected While isolated RBBB without symptoms or hemodynamic compromise may not require immediate intervention, the new onset during labor raises concern for acute cardiopulmonary events. Anesthesia consultation is also warranted to plan appropriate pain management, as hemodynamic changes during labor can worsen cardiac stress. The physiological basis for concern is that RBBB indicates delayed electrical conduction through the right bundle branch, potentially affecting right ventricular function during a time when the cardiovascular system is already under significant stress from labor. Close monitoring should continue throughout delivery and the immediate postpartum period, as hemodynamic shifts during this time can further stress the cardiovascular system, and studies like 3 and 4 highlight the importance of considering the impact of RBBB on cardiac function and outcomes. Given the potential for increased risk of mortality and morbidity associated with RBBB, as indicated by studies such as 1 which showed that RBBB was predictive of all-cause and cardiovascular-related mortality, and 2 which found RBBB to be associated with a higher risk of in-hospital mortality and complications in the setting of anterior wall ST-segment elevation myocardial infarction, prompt recognition and management of RBBB in the context of active labor are crucial to optimize patient outcomes.