Document Detail


A management strategy for fetal immune-mediated atrioventricular block.
MedLine Citation:
PMID:  20384469     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
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.
Authors:
Bettina F Cuneo; Maureen Lee; David Roberson; Alisa Niksch; Marc Ovadia; Barbara V Parilla; D Woodrow Benson
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2010-04-12
Journal Detail:
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:
Created Date:  2010-11-11     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101136916     Medline TA:  J Matern Fetal Neonatal Med     Country:  England    
Other Details:
Languages:  eng     Pagination:  1400-5     Citation Subset:  IM    
Affiliation:
The Heart Institute for Children, Hope Children's Hospital, Oak Lawn, IL 60453, USA. cuneo@thic.com
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MeSH Terms
Descriptor/Qualifier:
Grant Support
ID/Acronym/Agency:
HL69712/HL/NHLBI NIH HHS

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