Prediction of outcome in fetal autoimmune complete heart block

Area of Science:

• Maternal-Fetal Medicine
• Cardiology
• Immunology

Background:

• Autoimmune complete atrioventricular block (CAVB) poses challenges for fetal cardiac assessment.
• Maternal antibodies (anti-Sjögren syndrome type A [SSA] or anti-Sjögren syndrome type B [SSB]) can cause fetal CAVB.
• Risk stratification in these fetuses is crucial for management.

Purpose of the Study:

• To evaluate the cardiovascular profile score (CVP) and its components for surveillance in fetuses with autoimmune CAVB.
• To determine the predictive value of CVP for perinatal mortality in this cohort.

Main Methods:

• Retrospective cohort review of pregnancies with fetal CAVB.
• Exclusion of fetuses with significant congenital cardiac anomalies.
• Analysis of cardiovascular parameters including CVP, middle cerebral artery pulsatility index (MCA-PI), and umbilical artery pulsatility index (UA-PI).

Main Results:

• Seventeen fetuses with autoimmune CAVB were identified, diagnosed at a mean gestational age of 23 weeks.
• Overall mortality was 18% (termination, intrauterine fetal demise, postnatal death).
• High CVP scores were observed in all fetuses and did not correlate with mortality; however, abnormal MCA-PI and UA-PI were noted, with the lowest MCA-PI in fetuses that did not survive.

Conclusions:

• Cardiovascular profile score (CVP) may not be a reliable predictor of mortality in fetuses with autoimmune CAVB.
• Abnormalities in fetal cerebral blood flow (MCA-PI) and placental perfusion (UA-PI) may indicate altered hemodynamics and placental disease, potentially predicting adverse outcomes.
• Further research with larger cohorts is needed to confirm the predictive value of MCA-PI and UA-PI.