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- 저자 : ( Jose Mario Sabi (검색결과 1 건)
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( Pilar Brito Zeron ),( Marta Perez De Lis Novo ),( Pilar Rosich ),( Carles Tolosa ),( Joaquim Oristrell ),( Luis Saez Comet ),( Mercedes Perez Conesa ),( Jose Antonio Vargas Hitos ),( Jose Mario Sabi 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: To analyze the outcomes and therapeutic management of affected pregnancies with autoimmune congenital heart block (aCHB). Methods: Retrospective multicenter study in Internal Medicine Departments; inclusion criteria consisted of: aCHB of any type (I, II or III), fetal EFE and/or cardiomyopathy, cardiac block diagnosed in utero or in the first postpartum month, and mothers carrying anti-Ro52, Ro60 and/or La autoantibodies. Results: A total of 25 pregnancies with aCHB were retrospectively analyzed in 21 anti-Ro/La+ mothers. The mean maternal age at the time of pregnancy with aCHB was 33,25 years. Only 2 mothers received treatment prior to the first affected pregnancy (hydroxychloroquine and hydroxychloroquine+prednisone). Cardiac block consisted of type I (n=1), type II (n=6) and type III (n=18). At diagnosis of aCHB, 15/22 women were treated with dexamethasone (one of them, along with IVIG) and 2/22 with ritodrine. Preventive treatment with IVIG was administered in 2 pregnancies in which a recurrence was observed. Pregnancy was interrupted in 7/25 pregnancies at a mean week of 23.43 (18.2-37), while 18/25 of pregnancies gave a live birth baby with a mean age of 35.71 weeks of birth (30-40). 11 babies required pacemaker implantation, 9 immediately after birth and 2 in the neonatal period (1 at 5 years of age and another at 12). Of the 15 pregnancies with aCHB treated with dexamethasone, 12 achieved pregnancy to term (1 type II disappeared, with no changes in the remaining cases) and there were 3 fetal deaths despite treatment. Of the 7 pregnancies not treated with dexamethasone, 3 babies were born alive (no reversal of the blockade) and there were 4 fetal deaths. Conclusions: aCHB is a serious problem with a fetal mortality of 28% and a high requirement for neonatal pacemaker placement (61%).
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