| A management strategy for fetal immune-mediated atrioventricular block. | |
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MedLine Citation:
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PMID: 20384469 Owner: NLM Status: In-Process |
Abstract/OtherAbstract:
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INTRODUCTION: The purpose of this study is to describe an in utero management strategy for fetuses with immune-mediated 2° or 3° atrioventricular (AV) block. METHODS AND RESULTS: The management strategy as applied to 29 fetuses consisted of three parts. First, using fetal echocardiography and obstetrical ultrasound, we assessed fetal heart rate (FHR), heart failure, growth and a modified biophysical profile score (BPS) assessing fetal movement, breathing and tone. Second, we treated all fetuses with transplacental dexamethasone, adding terbutaline if the FHR was<56 bpm. Digoxin and/or intravenous immune globulin (IVIG) was added for progressive fetal heart failure. Third, we delivered fetuses by cesarean section for specific indications that included abnormal BPS, maternal/fetal conditions, progression of heart failure, or term pregnancy. We assessed perinatal survival, predictors of delivery and maternal/fetal complications in 29 fetuses with 3° (n=23) or 2° (n=6) AV block. There were no fetal deaths. In utero therapy included dexamethasone (n=29), terbutaline (n=13), digoxin (n=3) and/or IVIG (n=1). Delivery indications included term gestation (66%), fetal/maternal condition (14%), low BPS (10%) and progression of fetal heart failure (10%). An abnormal BPS correlated with urgent delivery. CONCLUSION: These results suggest that applying this specific management strategy that begins in utero can improve perinatal outcome of immune-mediated AV block. |
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Authors:
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Bettina F Cuneo; Maureen Lee; David Roberson; Alisa Niksch; Marc Ovadia; Barbara V Parilla; D Woodrow Benson |
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Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural Date: 2010-04-12 |
Journal Detail:
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Title: The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians Volume: 23 ISSN: 1476-4954 ISO Abbreviation: J. Matern. Fetal. Neonatal. Med. Publication Date: 2010 Dec |
Date Detail:
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Created Date: 2010-11-11 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101136916 Medline TA: J Matern Fetal Neonatal Med Country: England |
Other Details:
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Languages: eng Pagination: 1400-5 Citation Subset: IM |
Affiliation:
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The Heart Institute for Children, Hope Children's Hospital, Oak Lawn, IL 60453, USA. cuneo@thic.com |
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Descriptor/Qualifier:
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| Grant Support | |
ID/Acronym/Agency:
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HL69712/HL/NHLBI NIH HHS |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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