Foetal therapy, what works? An overview.

Area of Science:

• Cardiology
• Fetal Medicine
• Pediatric Cardiology

Background:

• A session on fetal cardiac therapy was held at the 2012 Association for European Paediatric and Congenital Cardiology meeting.
• Current fetal cardiac therapies lack robust evidence, with no randomized controlled trials (RCTs).

Purpose of the Study:

• To critically examine the evidence supporting or refuting proposed fetal cardiac therapies.
• To identify the limitations and challenges in establishing evidence for fetal cardiac interventions.

Main Methods:

• Review of existing literature and clinical experience regarding fetal cardiac therapies.
• Critical analysis of evidence for transplacental treatment of fetal tachyarrhythmias, steroid treatment for fetal atrioventricular block, and fetal aortic valvuloplasty.

Main Results:

• Evidence for the efficacy and safety of current fetal cardiac therapies is generally low.
• Transplacental treatment for fetal tachycardia is widely accepted but lacks drug consensus; RCTs are complicated by rarity and ethical considerations.
• Indications for steroid treatment in fetal atrioventricular block and fetal aortic valvuloplasty are more controversial, with significant challenges for RCTs.

Conclusions:

• There is a low level of evidence supporting current fetal cardiac therapies.
• Randomized controlled trials are desirable but face practical hurdles; multicenter registries may offer an alternative to improve evidence quality.