DIRECT FETAL THERAPY FOR HYDROPS SECONDARY TO CONGENITAL ATRIOVENTRICULAR HEART BLOCK

BACKGROUNDThe outcome for the fetus with hydrps fetalis secondary to complete congenital heart block is almost uniformly poor. Transplacental fetal therapy with inotropic drugs may be unreliable in the hydropic fetus. We describe our expereince of direct fetal therapy with digoxin and furosemide in...

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Published in:	Obstetrics and gynecology (New York. 1953) Vol. 87; no. 5, Part 2 Suppl; pp. 835 - 837
Main Authors:	Anandakumar, Chinnaya, Biswas, Arijit, Chew, Stephen S. L, DMU, Dawn Chia, Wong, Yee C, Ratnam, Shan S
Format:	Journal Article
Language:	English
Published:	New York, NY The American College of Obstetricians and Gynecologists 01-05-1996 Elsevier Science
Subjects:	Adult Biological and medical sciences Cardiotonic Agents - therapeutic use Digoxin - therapeutic use Diseases of mother, fetus and pregnancy Diuretics - therapeutic use Female Furosemide - therapeutic use Gynecology. Andrology. Obstetrics Heart Block - complications Heart Block - congenital Heart Block - drug therapy Humans Hydrops Fetalis - drug therapy Hydrops Fetalis - etiology Infant, Newborn Medical sciences Pregnancy Pregnancy Outcome Pregnancy. Fetus. Placenta Case study Human Fetal diseases Chemotherapy Treatment Pregnancy disorders Arrhythmia Congenital Hydrops fetalis Heart block Atrioventricular bloc Cardiovascular disease
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Summary:	BACKGROUNDThe outcome for the fetus with hydrps fetalis secondary to complete congenital heart block is almost uniformly poor. Transplacental fetal therapy with inotropic drugs may be unreliable in the hydropic fetus. We describe our expereince of direct fetal therapy with digoxin and furosemide in three cases. CASESIn the first two cases, fetal hydrops secondary to congential heart block was detected at 33 and 31 weeks. Direct fetal therapy with digoxin and fuosemide was given and the mothers received digomix and concurrently. The neonates were born normally at 35 weeks; one requried ventricular pacing, but both are currently alive and well. In the third case, fetal hydrops was detected at 24 weeks, when furosemide was used alone for direct fetal therapy. The mother developed chorioamnionitis at 29 weeks and was delivered by cesarean; the infant died of cardiac failure after 48 years. CONCLUSIONInitial direct fetal therapy with digoxin and furosemide followed by transplacental treatment with digoxin and direct fetal therapy with diuretics might improve the perinatal salvage of hydropic fetuses with congenital heart block. Treatment must be individualized because development of infection and preterm labor might defeat the objective.
Bibliography:	ObjectType-Case Study-2 SourceType-Scholarly Journals-1 ObjectType-Feature-4 content type line 23 ObjectType-Report-1 ObjectType-Article-3
ISSN:	0029-7844 1873-233X