title: Evaluation of transplacental treatment for fetal congenital bradyarrhythmia: – nationwide survey in Japan –.
abstract: BACKGROUND
  There are few large studies of fetal congenital bradyarrhythmia. The aim of the present study was to investigate the effects and risks of transplacental treatment for this condition.
  
  
  RESULTS
  Using questionnaires, 128 cases of fetal bradyarrhythmia were identified at 52 Japanese institutions from 2002 to 2008. Of the 128 fetuses, 90 had structurally normal hearts. Among these 90 fetuses, 61 had complete atrioventricular block (CAVB), 16 had second-degree AVB, 8 had sinus bradycardia, and 5 had other conditions. The 61 CAVB fetuses were divided into those who did (n = 38) and those who did not (n = 23) receive transplacental medication. Monotherapy with β-sympathomimetics, steroid monotherapy, and combination therapy with these agents was given in 11, 5 and 22 cases, respectively. Beta-sympathomimetics improved bradycardia (P<0.001), but no medication could significantly improve the survival rate. Fetal hydrops was associated with a 14-fold increased risk of perinatal death (P = 0.001), and myocardial dysfunction was a significant risk factor for poor prognosis (P = 0.034). Many adverse effects were observed with steroid treatment, with fetal growth restriction increasing significantly after >10 weeks on steroids (P = 0.043).
  
  
  CONCLUSIONS
  Treatment with β-sympathomimetics improved bradycardia, but survival rate did not differ significantly in fetuses with and without transplacental medication. It is recommended that steroid use should be limited to <10 weeks to avoid maternal and fetal adverse effects, especially fetal growth restriction and oligohydramnios.
authors.affiliation: National Cerebral and Cardiovascular Center, Kurume, Japan. gomiyoshi0327@yahoo.co.jp
authors.forename: Takekazu
authors.initials: T
authors.lastname: Miyoshi
authors.forename: Yasuki
authors.initials: Y
authors.lastname: Maeno
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Sago
authors.forename: Noboru
authors.initials: N
authors.lastname: Inamura
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yasukohchi
authors.forename: Motoyoshi
authors.initials: M
authors.lastname: Kawataki
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Horigome
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Yoda
authors.forename: Mio
authors.initials: M
authors.lastname: Taketazu
authors.forename: Makio
authors.initials: M
authors.lastname: Shozu
authors.forename: Motoki
authors.initials: M
authors.lastname: Nii
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Kato
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hayashi
authors.forename: Asako
authors.initials: A
authors.lastname: Hagiwara
authors.forename: Akiko
authors.initials: A
authors.lastname: Omoto
authors.forename: Wataru
authors.initials: W
authors.lastname: Shimizu
authors.forename: Isao
authors.initials: I
authors.lastname: Shiraishi
authors.forename: Heima
authors.initials: H
authors.lastname: Sakaguchi
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Nishimura
authors.forename: Keiko
authors.initials: K
authors.lastname: Ueda
authors.forename: Shinji
authors.initials: S
authors.lastname: Katsuragi
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Ikeda
mesh_terms: D054537:Atrioventricular Block / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D001919:Bradycardia / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D004359:Drug Therapy, Combination; D005260:Female; D005313:Fetal Death / Q000453:epidemiology* / Q000517:prevention & control; D005500:Follow-Up Studies; D019538:Health Care Surveys; D006801:Humans; D015160:Hydrops Fetalis / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D007231:Infant, Newborn; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D011247:Pregnancy; D011296:Prenatal Diagnosis; D012307:Risk Factors; D013256:Steroids / Q000627:therapeutic use*; D011795:Surveys and Questionnaires; D013566:Sympathomimetics / Q000627:therapeutic use*
chemical_list: D013256:Steroids; D013566:Sympathomimetics