What Is the Optimal Digoxin Level? Challenging Case of Fetal Atrial Flutter Treatment in a Monochorionic Diamniotic Twin

Background: Atrial flutter is an infrequent yet potentially fatal arrhythmia. Digoxin the preferred first-line treatment for fetal atrial due to its efficacy and favorable safety profile. The optimal digoxin serum target level neonatal management remains uncertain, with standard ranging from 1.0 2.0 ng/mL potential toxicity concerns above this threshold. Case Presentation: We present a case of in fetus within monochorionic diamniotic (MCDA) twin pregnancy that was successfully managed using higher-than-standard digoxin. A 34-year-old nulliparous woman referred our institution at 31 + 3 weeks gestation distress MCDA pregnancy. Fetal echocardiography revealed ventricular rate 214 bpm A, while B exhibited no abnormal findings. Conclusions: Our highlights distinct correlation between impact on flutter. higher may be necessary achieve sinus conversion unique maternal circulatory characteristics pregnancies.