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Prediction of outcome in fetal autoimmune complete heart block
Author(s) -
Sethi Neeta,
Krishnan Anita,
Donofrio Mary
Publication year - 2020
Publication title -
prenatal diagnosis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.956
H-Index - 97
eISSN - 1097-0223
pISSN - 0197-3851
DOI - 10.1002/pd.5637
Subject(s) - medicine , fetus , umbilical artery , cardiology , middle cerebral artery , gestational age , retrospective cohort study , intrauterine growth restriction , obstetrics , pregnancy , ischemia , genetics , biology
Assessing cardiac function and risk stratification in a fetal anti‐Sjögren syndrome type A (SSA) or anti‐Sjögren syndrome type B (SSB) complete atrioventricular block (CAVB) is challenging. We aimed to evaluate the cardiovascular profile score (CVP) and its components in surveillance of fetuses with autoimmune CAVB. Methods Retrospective cohort review of CAVB pregnancies, excluding fetuses with significant cardiac anomalies. Results CAVBs are in 17 fetuses, diagnosed at mean gestational age of 23 ± 5 weeks. Overall mortality is 18%: 1 termination, 1 fetal demise (intrauterine fetal demise [IUFD]), and 1 postnatal death. Both mortalities had intrauterine growth restriction; IUFD had placental infarction. Presenting CVP 8.7 ± 1. No fetus had CVP <7; the score correlated with increased risk of perinatal death. The 2 mortalities had initial CVP scores of 8 and 9; both increased to 10 on subsequent exams. 30% of fetuses had low middle cerebral artery pulsatility (MCA‐PI) on the last study. All had high umbilical artery pulsatility (UA‐PI) throughout gestation. The 2 deaths had the lowest MCA‐PI. Conclusion Despite low heart rates, high CVP scores in our cohort remained high and were not predictive of mortality. Abnormalities in MCA flow reflects fetal cerebral vasodilation that may indicate altered hemodynamics and be predictive of outcomes, but data is limited. Abnormal umbilical artery (UA) flow suggests that perinatal mortality may also be related to placental disease.