Prediction of outcome in fetal autoimmune complete heart block

Prediction of outcome in fetal autoimmune complete heart block:

Abstract

Assessing cardiac function and risk stratification in fetal anti‐SSA/SSB complete atrioventricular block (CAVB) is challenging. We aimed to evaluate the cardiovascular profile score (CVP) and its components in surveillance of fetuses with autoimmune CAVB.

Methods

Retrospective cohort review of CAVB pregnancies, excluding fetuses with significant cardiac anomalies.

Results

CAVB in 17 fetuses, diagnosed at mean gestational age of 23±5weeks. Overall mortality 18%: 1 termination, 1fetal demise (IUFD), and 1 postnatal death. Both mortalities had intrauterine growth restriction; IUFD had placental infarction.

Presenting CVP 8.7±1. No fetus had CVP <7; score correlated with increased risk of perinatal death. The 2 mortalities had initial CVP scores of 8 and 9; both increased to 10 on subsequent exams.

30% of fetuses had low middle cerebral artery pulsatility (MCA‐PI) on the last study. All had high umbilical artery pulsatility (UA‐PI) throughout gestation. The 2 deaths had the lowest MCA‐PI.

Conclusion

Despite low heart rates, high CVP scores in our cohort remained high and were not predictive of mortality. Abnormalities in MCA flow reflects fetal cerebral vasodilation that may indicate altered hemodynamics and be predictive of outcomes, but data is limited. Abnormal UA flow suggests that perinatal mortality may also be related to placental disease.

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