Prevent Fetal Complete Heart Block

Prevent Fetal Complete Heart BlockPrevent Fetal Complete Heart BlockPrevent Fetal Complete Heart Block
  • Lupus/Sjogren's Pregnancy
  • Lupus/Sjogren's & Baby
  • What we can do
  • Contact Us
  • FAQs
  • Our Protocol
  • More
    • Lupus/Sjogren's Pregnancy
    • Lupus/Sjogren's & Baby
    • What we can do
    • Contact Us
    • FAQs
    • Our Protocol

Prevent Fetal Complete Heart Block

Prevent Fetal Complete Heart BlockPrevent Fetal Complete Heart BlockPrevent Fetal Complete Heart Block
  • Lupus/Sjogren's Pregnancy
  • Lupus/Sjogren's & Baby
  • What we can do
  • Contact Us
  • FAQs
  • Our Protocol

FREQUENTLY ASKED QUESTIONS

MATERNAL SYMPTOMS

COMPLETE FETAL HEART BLOCK

COMPLETE FETAL HEART BLOCK

  1. Approximately 40–60% of mothers are asymptomatic when their babies are diagnosed to have NLE
  2. The remaining mothers may have

  • SLE,
  • Sj ̈ogren syndrome,
  • Rheumatoid arthritis, or
  • Undifferentiated Autoimmune disorder.
  • Mothers with primary Sj ̈ogren syndrome or undifferentiated autoimmune syndrome have a greater risk of delivering an infant with congenital Complete Heart Block than those with SLE

COMPLETE FETAL HEART BLOCK

COMPLETE FETAL HEART BLOCK

COMPLETE FETAL HEART BLOCK

  • Usually picked up at 20-24 wks
  • Pathology: Apoptosis of AV Node
  • Immunologically mediated
  • Can it be predicted by early Fetal Echo ?
  • Anticipation only if we check for the PR Interval on Fetal Echo and its prolongation
  • Can we assess Fetal PR Interval? 

WHAT GESTATIONAL AGE TO MONITOR IT

WHAT GESTATIONAL AGE TO MONITOR IT

WHAT GESTATIONAL AGE TO MONITOR IT

  • From 16 weeks to 20 weeks 
  • The molecule which causes apoptosis of AV node : Autoantibodies targeting the 52-kDa component of the Ro antigen remain the antibodies most closely associated with CHB 
  • If there is no CHB by 24 weeks there wont be

IMPACT OF CHB

WHAT GESTATIONAL AGE TO MONITOR IT

WHAT GESTATIONAL AGE TO MONITOR IT

  • If there is Complete Heart Block then it cannot be reversed (apoptosis of AV node) 
  • A first degree heart block can be reversed 
  • The test to diagnose first/second degree HB is of imperative importance

RECOMMENDATIONS

MANAGEMENT BEFORE PREGNANCY IN LUPUS MOTHER/MOTHER W PREV CHILD W CCHB

MANAGEMENT BEFORE PREGNANCY IN LUPUS MOTHER/MOTHER W PREV CHILD W CCHB

  • 16 Weeks gestation 
  • Monitoring of Mech PR 
  • Prophylactic steroids orally IF MECH PR PROLONGED

MANAGEMENT BEFORE PREGNANCY IN LUPUS MOTHER/MOTHER W PREV CHILD W CCHB

MANAGEMENT BEFORE PREGNANCY IN LUPUS MOTHER/MOTHER W PREV CHILD W CCHB

MANAGEMENT BEFORE PREGNANCY IN LUPUS MOTHER/MOTHER W PREV CHILD W CCHB

  • Priortopregnancycheckanti-Ro/La 
  • If strongly positive: better to start HCQ 
  • May check again at 12 weeks

MANAGEMENT WHEN MOTHER PRESENTS RHO/LA POSITIVE AT 12-14 WEEKS

MANAGEMENT WHEN MOTHER PRESENTS RHO/LA POSITIVE AT 12-14 WEEKS

MANAGEMENT WHEN MOTHER PRESENTS RHO/LA POSITIVE AT 12-14 WEEKS

  • Test for RHO LA  
  • If Levels Positive   
  • Start Steroids DEXAMETHASONE  
  • Best to enter 14-16 week period with a low level of Anti Rho/La  
  • If pt positive may want to cover her with steroids between 14-22 week period  
  • Dexamethasone 2-4 mg bd orally is enough to cover this period

MANAGEMENT IF PT PRESENTS IN SECOND DEGREE HEART BLOCK

MANAGEMENT WHEN MOTHER PRESENTS RHO/LA POSITIVE AT 12-14 WEEKS

MANAGEMENT WHEN MOTHER PRESENTS RHO/LA POSITIVE AT 12-14 WEEKS

  • The Heart Block is still reversible   
  • IV high dose METHYL PREDNISOLONE may be considered  
  • Daily monitoring of Mechanical PR Interval may be important  
  • If intermittent Second Degree Heart Block Oral Steroids may be of choice   
  • PLASMAPHARESIS and  IVIG have also been reported but we haven't been in situation to use it!! 

ESTABLISHED COMPLETE HEART BLOCK: HOW TO MANAGE

  • The aim now is to take the baby as far in pregnancy as possible  
  • Hydrops may happen and may best be prevented by increasing by increasing Heart rate slightly by giving SALBUTAMOL 
  • If onset of HYDROPS noted, SALBUTAMOL may still help to reverse it (2 PATIENTS-DELIVERED NEAR TERM, BABIES >6 MOTNHS) 
  • Again keeping maternal Antibody levels in control also important  
  • STEROIDS at this stage may only be used of  FETAL ENDOCARDIAL FIBROELASTOSIS (4 PATIENTS-REVERSED EFE WITH STEROIDS)

Lupus and Pregnancy

Please reach us at vkohli_md@yahoo.com if you cannot find an answer to your question.

Early talks with your doctor will allow you to have a plan for a safe pregnancy. You may need to change your lupus medicines 3 to 6 months  before you start trying, so planning ahead is important.


Everyone with lupus has a higher risk of pregnancy complications. But some things may raise your risk even more, like:  

  1. High blood pressure 
  2. Kidney problems 
  3. Problems with your blood, like blood clots or not having enough platelets 
  4. Having a certain type of proteins (called antiphospholipid antibodies) in your blood that may increase your risk for blood clots and pregnancy loss. 


Your risk is still higher if you had these problems in the past, even if you don’t have them now. Your risk is also higher if you had complications during a past pregnancy.


That depends on which medicines you’re taking. Some lupus medicines, are safe to take during pregnancy. But some other lupus medicines, can cause serious birth defects. It’s also important to know that some lupus medicines can stay in your body for several months after you stop taking them. You may need to stop or switch treatments up to 3/4 months before you start trying to get pregnant.


Early talks with your doctor will allow you to have a plan for a safe pregnancy. You may need to change your lupus medicines 3 to 6 months  before you start trying, so planning ahead is important.


Everyone with lupus has a higher risk of pregnancy complications. But some things may raise your risk even more, like:  

  1. High blood pressure 
  2. Kidney problems 
  3. Problems with your blood, like blood clots or not having enough platelets 
  4. Having a certain type of protein (called antiphospholipid antibodies) in your blood may increase your risk for blood clots and pregnancy loss. 


Your risk is still higher if you had these problems in the past, even if you don’t have them now. Your risk is also higher if you had complications during a past pregnancy.


Preeclampsia is a serious blood pressure problem that happens during pregnancy. If it’s not treated early, it can cause other health problems including kidney damage, problems with blood clotting, and seizures.   


People with lupus are at higher risk for preeclampsia and a related condition called HELLP syndrome. HELLP syndrome causes serious problems with the liver and blood.   


Preeclampsia can be very dangerous — but the early treatment makes a big difference. Get help right away if you have any of these symptoms while you’re pregnant:  

  • Blurry vision or sudden changes in your vision 
  • Severe headaches 
  • Severe pain in your upper abdomen (usually under your ribs on the right side) 
  • Trouble breathing or severe shortness of breath


Prevent Fetal Complete Heart Block

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