We read with interest the algorithm suggested by Adekanye et al. for the management of bradyarrhythmias in pregnancy and labor.1 Recently, a 21-year-old (G2P1) parturient presented to our emergency department at 37 weeks of gestation with thrombosed external hemorrhoids. Due to increasing pain and possibility of severe bleeding with vaginal delivery, she was admitted for hemorrhoidectomy. Her past medical history included congenital complete heart block (CCHB) diagnosed incidentally immediately postpartum following her first, uneventful pregnancy.The patient had remained asymptomatic and refused permanent pacemaker placement before her second pregnancy.
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