Tseng J J, Chou M M, Ho E S
Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taiwan, ROC.
Zhonghua Yi Xue Za Zhi (Taipei). 2000 Sep;63(9):679-85.
The perinatal management of congenital complete heart block (CCHB) remains controversial. The purpose of this study was to present a therapeutic modality for CCHB.
We collected retrospective cases of all pregnant women admitted to our hospital between January 1992 and June 1999 whose babies developed CCHB antenatally. After a series of examinations, maternal, fetal and neonatal data were analyzed.
Nine fetuses from six mothers (cases 1-6) in nine different pregnancies were studied. In case 1, both consecutive fetuses had CCHB and in case 2, all three consecutive fetuses had CCHB. The other mothers (cases 3-6) had only one fetus each with CCHB. Of the seven fetuses with isolated CCHB, four underwent observation only due to late-onset, or nonimmunologic CCHB, two received dexamethasone and/or intravenous immunoglobulin therapy because of the presence of hydropic signs, and one received dexamethasone at 23 weeks' gestation due to early-onset CCHB. Shortening fractions of the right ventricle had good compensation in four fetuses, without any treatment, and improving compensation in two of three fetuses receiving dexamethasone therapy. All seven fetuses were delivered smoothly and pacemakers were implanted shortly after birth. Two other fetuses had a poor outcome due to associated ventricular septal defect or hemoglobin Bart's disease. Furthermore, we gave dexamethasone (2 mg/day) instead of prednisolone (10 mg/day) for the next pregnancies of patients 3 to 5, beginning at 12 weeks of gestation. No fetal CCHB developed again.
For pregnant women with previous fetal immunologic CCHB, early initiation of dexamethasone instead of prednisolone might be effective to cross the placenta and avoid recurrences. Dexamethasone is also effective for fetal CCHB of early onset, fetal hydrops or heart failure. Observation only is suggested for nonimmunologic CCHB and remote or late-onset immunologic CCHB. Other modalities were tried for very sick fetuses, but their effectiveness was not predictable.
先天性完全性心脏传导阻滞（CCHB）的围产期管理仍存在争议。本研究的目的是提出一种针对CCHB的治疗方式。
我们收集了1992年1月至1999年6月期间我院收治的所有产前胎儿发生CCHB的孕妇的回顾性病例。经过一系列检查后，对母亲、胎儿及新生儿的数据进行了分析。
研究了来自6位母亲（病例1 - 6）的9例不同妊娠中的9例胎儿。病例1中，连续的两个胎儿均患有CCHB；病例2中，连续的三个胎儿均患有CCHB。其他母亲（病例3 - 6）各自仅有一个胎儿患有CCHB。在7例孤立性CCHB胎儿中，4例因发病较晚或非免疫性CCHB仅接受观察，2例因出现水肿体征接受了地塞米松和/或静脉注射免疫球蛋白治疗，1例因早发性CCHB在妊娠23周时接受了地塞米松治疗。4例未接受任何治疗的胎儿右心室缩短分数代偿良好，接受地塞米松治疗的3例胎儿中有2例代偿情况得到改善。所有7例胎儿均顺利分娩，出生后不久即植入了起搏器。另外2例胎儿因合并室间隔缺损或巴氏血红蛋白病预后不良。此外，对于病例3至5的患者，我们在其下次妊娠时从妊娠12周开始给予地塞米松（2毫克/天）而非泼尼松龙（10毫克/天）。未再发生胎儿CCHB。
对于既往胎儿患有免疫性CCHB的孕妇，早期使用地塞米松而非泼尼松龙可能有效穿过胎盘并避免复发。地塞米松对早发性胎儿CCHB、胎儿水肿或心力衰竭也有效。对于非免疫性CCHB以及远期或晚发性免疫性CCHB，建议仅进行观察。对于病情严重的胎儿尝试了其他治疗方式，但其效果不可预测。
