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Beat by beat : Navigating ventricular bigeminy in pregnancy Dr. Rajalakshmi S This report details the case of a 34-year-old, G3P2L2, who presented with incidental ventricular bigeminy during a routine antenatal exam. With no significant symptoms or history of cardiovascular disease, she remained hemodynamically stable and successfully delivered vaginally. This case highlights conservative management and close monitoring of ventricular bigeminy in pregnancy. Case Report A 34-year-old woman, G3P2L2, was found to have ventricular bigeminy on ECG during a routine antenatal visit at 32 weeks. She reported occasional palpitations without syncope, chest pain, or shortness of breath. Blood pressure and oxygen saturation were normal, and echocardiography showed no structural heart abnormalities. She was managed conservatively with follow-up ECGs and cardiology assessments. Given her stability, no pharmacological intervention was required. At 39 weeks, she was admitted for spontaneous labor. Continuous fetal monitoring showed a reassuring fetal heart rate. The patient?s ECG continued to show ventricular bigeminy without progression. Vital signs remained stable throughout labor. She delivered a healthy infant vaginally, with Apgar scores of 8 and 9 at 1 and 5 minutes, respectively. Postpartum, her ECG still showed ventricular bigeminy, but she remained asymptomatic. She was discharged on day 2 with instructions to follow up with cardiology for continued monitoring. Discussion Ventricular bigeminy in pregnancy, often benign, can be managed conservatively in the absence of symptoms or structural heart disease. Pregnancy-induced hemodynamic changes may exacerbate arrhythmias; however, careful monitoring usually ensures safe outcomes. This case demonstrates that asymptomatic ventricular bigeminy, with proper management, can lead to an uncomplicated delivery. Conclusion With vigilant monitoring and appropriate care, ventricular bigeminy in pregnancy can result in favorable maternal and fetal outcomes, even with a vaginal delivery. `