First‐degree heart block in the fetus of an anti‐SSA/Ro–positive mother: Reversal after a short course of dexamethasone treatment

Abstract

Isolated congenital heart block is almost invariably associated with the presence of antibodies to SSA/Ro and SSB/La antigens in the maternal circulation. Once established, third-degree congenital heart block is permanent. However, a lesser degree of autoantibody-associated heart block in a fetus can be reversed if it is recognized and treated early enough with fluorinated glucocorticosteroids. The only method available clinically for the recognition of first-degree heart block in a fetus is measurement of the mechanical PR interval by pulsed Doppler echocardiography. This is the first report of a fetus in whom a diagnosis of first-degree heart block and the consequent decision to intervene were based solely on this technique. In addition, the first-degree heart block resolved completely after only 2 weeks of dexamethasone treatment, and the heart rhythm remained stable throughout the remainder of the pregnancy despite early discontinuation of therapy due to oligohydramnios.

Neonatal Lupus Erythematosus (NLE)

“…The use of echocardiographic monitoring may present a way to more selective use interventions to prevent or reverse the development of more advanced heart block. Fetal monitoring may include a biophysical profile and non-stress test [Vesel, 2004;Sonesson, 2004].…”

Fetal arrhythmias

“…The question remains as to whether identifying such early echocardiographic changes justifies initiation of dexamethasone with the aim of prevention of development of either second‐degree or complete heart block. One case report50 described normalization of the PR interval following treatment with corticosteroids. However, further reports have suggested that a third of fetuses of anti‐Ro/La‐positive mothers have prolongation of the mechanical PR interval and that spontaneous normalization of the mechanical PR interval may occur51.…”

Gynäkologische und geburtshilfliche Probleme beim Sjögren-Syndrom

“…Dies ist auch die Zeit, in welcher versucht werden kann, durch die Gabe von im Gegensatz zum Prednisolon plazentagängigen, fluorierten Kortikosteroiden (z. B. Dexamethason) bei der Mutter, diese Entwicklung eines kAVB zu verhindern [12,13]. Es herrscht aber keineswegs Konsens über Sinn und Wirksamkeit einer solchen prophylaktischen Therapie 11,12 und ein einmal eingetretener kompletter fetaler AVB gilt als irreversibel.…”