Faculty Collaboration Database

Heart sounds at home: feasibility of an ambulatory fetal heart rhythm surveillance program for anti-SSA-positive pregnancies. J Perinatol 2017 Mar;37(3):226-230

Date

12/16/2016

Pubmed ID

27977016

DOI

10.1038/jp.2016.220

Scopus ID

2-s2.0-85006289185 (requires institutional sign-in at Scopus site)   33 Citations

Abstract

OBJECTIVE: Fetuses exposed to anti-SSA (Sjögren's) antibodies are at risk of developing irreversible complete atrioventricular block (CAVB), resulting in death or permanent cardiac pacing. Anti-inflammatory treatment during the transition period from normal heart rhythm (fetal heart rhythm (FHR)) to CAVB (emergent CAVB) can restore sinus rhythm, but detection of emergent CAVB is challenging, because it can develop in ⩽24 h. We tested the feasibility of a new technique that relies on home FHR monitoring by the mother, to surveil for emergent CAVB.

STUDY DESIGN: We recruited anti-SSA-positive mothers at 16 to 18 weeks gestation (baseline) from 8 centers and instructed them to monitor FHR two times a day until 26 weeks, using a Doppler device at home. FHR was also surveilled by weekly or every other week fetal echo. If FHR was irregular, the mother underwent additional fetal echo. We compared maternal stress/anxiety before and after monitoring. Postnatally, infants underwent a 12-lead electrocardiogram.

RESULTS: Among 133 recruited, 125 (94%) enrolled. Among those enrolled, 96% completed the study. Reasons for withdrawal (n=5) were as follows: termination of pregnancy, monitoring too time consuming or moved away. During home monitoring, 9 (7.5%) mothers detected irregular FHR diagnosed by fetal echo as normal (false positive, n=2) or benign atrial arrhythmia (n=7). No CAVB was undetected or developed after monitoring. Questionnaire analysis indicated mothers felt comforted by the experience and would monitor again in future pregnancies.

CONCLUSION: These data suggest ambulatory FHR surveillance of anti-SSA-positive pregnancies is feasible, has a low false positive rate and is empowering to mothers.

Author List

Cuneo BF, Moon-Grady AJ, Sonesson SE, Levasseur S, Hornberger L, Donofrio MT, Krishnan A, Szwast A, Howley L, Benson DW, Jaeggi E

MESH terms used to index this publication - Major topics in bold

Adult
Antibodies, Antinuclear
Atrioventricular Block
Female
Fetal Monitoring
Gestational Age
Heart Rate, Fetal
Heart Sounds
Humans
Monitoring, Ambulatory
Pregnancy
Pregnancy Complications
Prenatal Care
Prospective Studies
Ultrasonography, Doppler
United States