Steroid therapy for hydrops associated with antibody-mediated congenital heart block

Article Abstract:

In autoimmune diseases such as rheumatoid arthritis, which are characterized by production of autoantibodies (antibodies inappropriately produced against the body's own tissues), disease severity may diminish during treatment with steroids. Complete congenital heart block (altered heart rhythm caused by improper development of the impulse-conducting system) in fetuses, associated with maternal autoantibodies, is associated with the development of hydrops fetalis (fluid accumulation). A case is reported of fetal heart block associated with autoantibodies, which improved substantially within one week of starting steroid treatment. Fetal anatomy was normal according to ultrasound imaging at 15 weeks of gestation, but the heart rate at 24 weeks was 60 beats per minute, roughly half the normal rate. Fluid accumulated in the sac surrounding the heart. Two types of autoantibodies were identified in maternal blood, antinuclear antibody (directed against a structure in the nucleus of cells), and another called anti-La (SSB) antibody. The patient was given injections of betamethasone for two days and then prednisone was given daily for one week. Fluid accumulation in the body and around the heart resolved after one week, although the heart rate had not changed. This second steroid was then gradually decreased in dose. Fetal size did not increase between 33 and 35 weeks of gestation, and a 4.8 pound infant was delivered by cesarean section at 35 weeks. Due to mild congestive heart failure, a pacemaker was implanted at five weeks, and the infant was well at six months of age. The report indicates that maternal steroid treatment may be useful in treating antibody-mediated heart block accompanied by hydrops fetalis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Case studies, Drug therapy, Autoimmune diseases, Congenital heart disease, Congenital heart defects, Pregnancy, Betamethasone, Heart block, Hydrops fetalis, Autoimmune diseases in pregnancy

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Fetal urine output does not influence residual amniotic fluid volume after premature rupture of membranes

Article Abstract:

When the amniotic sac, which surrounds the fetus, ruptures prematurely, fetal well-being is jeopardized. In cases where the volume of the remaining amniotic fluid is low, fetal urine production may be compromised, leading to complications. This was studied using ultrasonography in 12 women whose membranes ruptured at 26 to 34 weeks' gestation; results from these subjects were compared with results from 12 pregnant women without membrane rupture. Fetal urine output was not different for women in the two groups (approximately 11 milliliters per kilogram per hour), and no correlation was found between amniotic fluid volume and fetal urine output. After premature rupture of the fetal membranes, fetuses may be at risk for intrauterine growth retardation; another study found a relationship between this complication and low urine output. However, it did not appear that fetal urine output in these cases was affected by premature rupture of the membranes, even when the remaining amniotic fluid volume was greatly reduced. (Consumer Summary produced by Reliance Medical Information, Inc.)

Measurement, Complications and side effects, Fetus, Premature rupture of membranes, Premature rupture of the membrane, Amniotic fluid

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