Envain François, Vandendriessche David, Mehros Wala, Houfflin-Debarge Véronique, Garabedian Charles, Rakza Thameur
Hôpital Jeanne de Flandre, clinique d'obstétrique, CHU de Lille, 59037 Lille Cedex, France.
Hôpital Jeanne de Flandre, clinique d'obstétrique, CHU de Lille, 59037 Lille Cedex, France.
J Gynecol Obstet Hum Reprod. 2019 Oct;48(8):699-701. doi: 10.1016/j.jogoh.2019.05.002. Epub 2019 May 8.
Fetal atrioventricular block is a rare pathology, mostly due to placental transmission of maternal SSA/Ro and SSB/La antibodies, and can lead to severe fetal or neonatal outcomes. We report a case of dichorionic, diamniotic twin pregnancy, with maternal SSA/Ro antibodies. Isolated complete atrioventricular block was diagnosed at 23 weeks in one fetus (Twin A), while the second fetus (Twin B) remained in normal sinus rhythm. Severe asymmetric intrauterine growth restriction occurred in Twin A. Delivery was by caesarean section at 32 + 2 weeks. Neonatal permanent pacemaker was inserted on the first day after birth in 1140 g neonate. Discordant heart block in twin pregnancy has already been reported in a few dichorionic pregnancies, but the pathway of discordant disease expression remains unclear. Extraction decision is a dilemma between cardiac failure prevention and prematurity associated twin morbidity. This case shows a successful pacing in a very low birth weight neonate.
胎儿房室传导阻滞是一种罕见的病症，主要由母体抗SSA/Ro和抗SSB/La抗体经胎盘传播引起，可导致严重的胎儿或新生儿结局。我们报告一例双绒毛膜、双羊膜囊双胎妊娠病例，母体存在抗SSA/Ro抗体。在一个胎儿（A双胎）23周时诊断出孤立性完全性房室传导阻滞，而另一个胎儿（B双胎）维持正常窦性心律。A双胎出现严重的不对称性宫内生长受限。在32 + 2周时行剖宫产分娩。出生体重1140g的新生儿在出生后第一天植入了永久性心脏起搏器。双胎妊娠中不一致性心脏传导阻滞在少数双绒毛膜妊娠中已有报道，但不一致性疾病表现的途径仍不清楚。在预防心力衰竭和早产相关的双胎发病之间做出引产决定是一个两难的问题。本病例显示在极低出生体重的新生儿中成功进行了起搏治疗。
