Author + information
- Received May 18, 2018
- Revision received July 6, 2018
- Accepted July 9, 2018
- Published online October 8, 2018.
- Bettina F. Cuneo, MDa,∗ (, )@ChildrensColo,
- Sven-Erik Sonesson, MDb,
- Stephanie Levasseur, MDc,
- Anita J. Moon-Grady, MDd,
- Anita Krishnan, MDe,
- Mary T. Donofrio, MDe,
- Marie-Josee Raboisson, MDf,
- Lisa K. Hornberger, MDg,
- Peter Van Eerden, MDh,
- Elena Sinkovskaya, MDi,
- Alfred Abuhamad, MDi,
- Bhawna Arya, MDj,
- Anita Szwast, MDk,
- Helena Gardiner, MDl,
- Katherine Jacobs, MDm,
- Grace Freire, MDn,
- Lisa Howley, MDa,
- Aimee Lam, BSa,
- Alexander M. Kaizer, PhDo,
- D. Woodrow Benson, MD, PhDp and
- Edgar Jaeggi, MDq
- aDivision of Cardiology, Department of Pediatrics, Children’s Hospital Colorado, Aurora, Colorado
- bDepartment of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
- cDivision of Cardiology, Department of Pediatrics, New York-Presbyterian Morgan Stanley Children’s Hospital, New York, New York
- dDivision of Cardiology, Department of Pediatrics, Benioff Children’s Hospital, San Francisco, California
- eDivision of Cardiology, Department of Pediatrics, Children’s National Medical Center, Washington, DC
- fDivision of Cardiology, Department of Pediatrics, St. Justine Hospital, Montreal, Canada
- gDivision of Cardiology, Department of Pediatrics, Stollery Children’s Hospital, Calgary, Canada
- hSanford Health Maternal Fetal Medicine, Fargo, North Dakota
- iDivision of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Eastern Virginia School of Medicine, Norfolk, Virginia
- jDivision of Cardiology, Department of Pediatrics, Seattle Children’s Hospital, Seattle, Washington
- kDivision of Cardiology, Department of Pediatrics, Children’s Hospital Philadelphia, Philadelphia, Philadelphia
- lDivision of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Health Sciences Center, Houston, Texas
- mDivision of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Minnesota Hospital, Minneapolis, Minnesota
- nDivision of Cardiology, Department of Pediatrics, Johns Hopkins All Children’s Hospital, St. Petersburg, Florida
- oDepartment of Biostatistics and Informatics, University of Colorado, Aurora, Colorado
- pDepartment of Pediatrics, Children’s Hospital of Wisconsin, Milwaukee, Wisconsin
- qDivision of Cardiology, Department of Pediatrics, Hospital for Sick Children, Toronto, Canada
- ↵∗Address for correspondence:
Dr. Bettina F. Cuneo, The Colorado Fetal Care Center, Children’s Hospital Colorado, 13123 East 16th Avenue, Box 100, Aurora, Colorado 80045.
Background Fetal atrioventricular block (AVB) occurs in 2% to 4% of anti-Ro antibody–positive pregnancies and can develop in <24 h. Only rarely has standard fetal heart rate surveillance detected AVB in time for effective treatment.
Objectives Outcome of anti-Ro pregnancies was surveilled with twice-daily home fetal heart rate and rhythm monitoring (FHRM) and surveillance echocardiography.
Methods Anti-Ro pregnant women were recruited from 16 international centers in a prospective observational study. Between 18 and 26 weeks’ gestation, mothers checked FHRM twice daily with a commercially available Doppler monitor and underwent weekly or biweekly surveillance fetal echocardiograms. If FHRM was abnormal, a diagnostic echocardiogram was performed. Cardiac cycle length and atrioventricular interval were measured, and cardiac function was assessed on all echocardiograms. After 26 weeks, home FHRM and echocardiograms were discontinued, and mothers were monitored during routine obstetrical visits. Postnatal electrocardiograms were performed.
Results Most mothers (273 of 315, 87%) completed the monitoring protocol, generating 1,752 fetal echocardiograms. Abnormal FHRM was detected in 21 mothers (6.7%) who sought medical attention >12 h (n = 7), 3 to 12 h (n = 9), or <3 h (n = 5) after abnormal FHRM. Eighteen fetuses had benign rhythms, and 3 had second- or third-degree AVB. Treatment of second-degree AVB <12 h after abnormal FHRM restored sinus rhythm. Four fetuses had first-degree AVB diagnosed by echocardiography; none progressed to second-degree AVB. No AVB was missed by home FHRM or developed after FHRM.
Conclusions Home FHRM confirms the rapid progression of normal rhythm to AVB and can define a window of time for successful therapy. (Prospective Maternal Surveillance of SSA [Sjögren Syndrome A] Positive Pregnancies Using a Hand-held Fetal Heart Rate Monitor; NCT02920346)
Dr. Sinkovskaya has been a consultant for GE Ultrasound. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 18, 2018.
- Revision received July 6, 2018.
- Accepted July 9, 2018.
- 2018 American College of Cardiology Foundation
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