Bettina F Cuneo1, Sven-Erik Sonesson2, Stephanie Levasseur3, Anita J Moon-Grady4, Anita Krishnan5, Mary T Donofrio5, Marie-Josee Raboisson6, Lisa K Hornberger7, Peter Van Eerden8, Elena Sinkovskaya9, Alfred Abuhamad9, Bhawna Arya10, Anita Szwast11, Helena Gardiner12, Katherine Jacobs13, Grace Freire14, Lisa Howley15, Aimee Lam15, Alexander M Kaizer16, D Woodrow Benson17, Edgar Jaeggi18. 1. Division of Cardiology, Department of Pediatrics, Children's Hospital Colorado, Aurora, Colorado. Electronic address: bettina.cuneo@childrenscolorado.org. 2. Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden. 3. Division of Cardiology, Department of Pediatrics, New York-Presbyterian Morgan Stanley Children's Hospital, New York, New York. 4. Division of Cardiology, Department of Pediatrics, Benioff Children's Hospital, San Francisco, California. 5. Division of Cardiology, Department of Pediatrics, Children's National Medical Center, Washington, DC. 6. Division of Cardiology, Department of Pediatrics, St. Justine Hospital, Montreal, Canada. 7. Division of Cardiology, Department of Pediatrics, Stollery Children's Hospital, Calgary, Canada. 8. Sanford Health Maternal Fetal Medicine, Fargo, North Dakota. 9. Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Eastern Virginia School of Medicine, Norfolk, Virginia. 10. Division of Cardiology, Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington. 11. Division of Cardiology, Department of Pediatrics, Children's Hospital Philadelphia, Philadelphia, Philadelphia. 12. Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Health Sciences Center, Houston, Texas. 13. Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Minnesota Hospital, Minneapolis, Minnesota. 14. Division of Cardiology, Department of Pediatrics, Johns Hopkins All Children's Hospital, St. Petersburg, Florida. 15. Division of Cardiology, Department of Pediatrics, Children's Hospital Colorado, Aurora, Colorado. 16. Department of Biostatistics and Informatics, University of Colorado, Aurora, Colorado. 17. Department of Pediatrics, Children's Hospital of Wisconsin, Milwaukee, Wisconsin. 18. Division of Cardiology, Department of Pediatrics, Hospital for Sick Children, Toronto, Canada.
Abstract
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).
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).
Authors: Jay D Pruetz; Jennifer C Miller; Gerald E Loeb; Michael J Silka; Yaniv Bar-Cohen; Ramen H Chmait Journal: Birth Defects Res Date: 2019-03-01 Impact factor: 2.344
Authors: Justin Pick; Michael J Silka; Yaniv Bar-Cohen; Allison Hill; Mark Shwayder; John Wood; Jay D Pruetz Journal: Pediatr Cardiol Date: 2021-09-12 Impact factor: 1.655
Authors: Peter Izmirly; Mimi Kim; Deborah M Friedman; Nathalie Costedoat-Chalumeau; Robert Clancy; Joshua A Copel; Colin K L Phoon; Bettina F Cuneo; Rebecca E Cohen; Kimberly Robins; Mala Masson; Benjamin J Wainwright; Noel Zahr; Amit Saxena; Jill P Buyon Journal: J Am Coll Cardiol Date: 2020-07-21 Impact factor: 24.094