John Libbey Eurotext

Médecine de la Reproduction

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Management of fetal arrythmia Volume 12, issue 2, avril-mai-juin 2010

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Evaluation et Traitement des Cardiopathies Congénitales 8, avenue du Conseil de l’Europe, 91300 Massy

The diagnosis of a fetal arrythmia is a disturbing finding for the obstetricians and the fetal echographists: even if severe arrythmias are rare, their consequences on the fetus can be devastating, with a risk of hydrops in 40 to 60 %. This risk is not acceptable since most of these severe arrythmias involve otherwise normal hearts. When diagnosed soon enough, they can be efficiently treated. The necessity of a treatment and the modalities of this treatment depend upon the type of tachycardia, the timing of the arrythmia and its cardiac tolerance. The more frequently used drugs are digoxin, sotalol, flecainid and amiodarone. In the presence of bradycardia, an atrio-venticular block must be suspected. In most cases, this block is secondary to fetal myocarditis by passive auto-immunisation. This complication happens when the mother has anti-SSA or anti-SSb auto-antibodies. Corticoids are unefficient in the cases of complete A-V block. However, they can improve some cases of first or second grade block. This justifies the detection as soon as the 16th week of pregnancy in all the mothers who have these antibodies.