Kothandaraman Keerthana, Ganesan Ponmozhi, Nadig Ns Vikram, Manikandan K
The Fetal Clinic, No.8, Bajanai Madam Street, Ellaipillaichavady, Puducherry, 605005, India.
The Fetal Clinic, No.8, Bajanai Madam Street, Ellaipillaichavady, Puducherry, 605005, India.
Indian Pacing Electrophysiol J. 2024 Jan-Feb;24(1):20-24. doi: 10.1016/j.ipej.2023.10.003. Epub 2023 Oct 13.
Prenatal diagnosis of Fetal bradyarrhythmia leads to parental and care provider anxiety as data on outcome is scarce. We aimed to correlate the prenatal presentation of fetal bradyarrhythmia with postnatal outcome.
Retrospective analysis of case records from 2017 to 2021. All fetuses with sustained bradyarrhythmia beyond 11 weeks were included in the study.
Twenty fetuses were identified: mean gestational age at diagnosis was 23 weeks 2 days. The type of bradyarrhythmia was as follows: Complete atrioventricular block 10 (50 %), Sinus Bradycardia 7 (35 %), second degree atrioventricular block 2 (10 %), and Unclassified 1 (5 %). In 10 fetuses, cardiac and extracardiac anatomy were normal; 8 fetuses (40 %) had cardiac anomalies,1 fetus had intraventricular hemorrhage and 1 had nuchal cystic hygroma. Among the fetuses with associated anomalies, there were 5 terminations of pregnancy (TOP), 1 intrauterine fetal demise (IUD), 3 neonatal demise (NND) and 1 livebirth. Among fetuses with normal anatomy, there were 2 TOP and 8 livebirths; five of the 10 mothers (50 %) tested positive for Anti Ro/La antibodies. All the 6 liveborn fetuses with complete atrioventricular block are on conservative management: 2 on metaproterenol and 4 on clinical follow up. Nine out of the 10 cases that had a postnatal paediatric cardiology assessment had a correct prenatal diagnosis.
Correct prenatal identification of fetal bradyarrhythmia is feasible in about 90 % of cases. The risk of postnatal pacemaker requirement appears to be low irrespective of maternal Anti Ro/La status.
胎儿心动过缓的产前诊断会导致父母及医护人员焦虑，因为关于其预后的数据稀缺。我们旨在将胎儿心动过缓的产前表现与产后结局相关联。
对2017年至2021年的病例记录进行回顾性分析。研究纳入了所有孕11周后出现持续性心动过缓的胎儿。
共识别出20例胎儿：诊断时的平均孕周为23周2天。心动过缓的类型如下：完全性房室传导阻滞10例（50%），窦性心动过缓7例（35%），二度房室传导阻滞2例（10%），未分类1例（5%）。10例胎儿的心脏和心外解剖结构正常；8例胎儿（40%）有心脏异常，1例有脑室内出血，1例有颈部囊状水瘤。在伴有相关异常的胎儿中，有5例终止妊娠（TOP），1例宫内胎儿死亡（IUD），3例新生儿死亡（NND）和1例活产。在解剖结构正常的胎儿中，有2例TOP和8例活产；10名母亲中有5名（50%）抗Ro/La抗体检测呈阳性。所有6例出生时患有完全性房室传导阻滞的活产胎儿均采用保守治疗：2例使用间羟异丙肾上腺素，4例进行临床随访。10例产后接受儿科心脏病学评估的病例中有9例产前诊断正确。
约90%的病例中胎儿心动过缓的产前正确识别是可行的。无论母亲抗Ro/La状态如何，产后需要起搏器的风险似乎都很低。
