Tek Merkezde Yapılan Bölgesel Fetal Aritmi Tarama Sonuçları ve Postnatal Takip Güncel Sonuçları

Year 2023, Volume: 11 Issue: 3, 187 - 192, 15.10.2023

Derya Duman , Hasan Demetgül

Abstract

Amaçlar
Fetal aritmiler gebelikte karşılaşılan önemli hastalıklardan birisidir ve fetal iyilik halini belirleyen önemli bir sağlık sorunudur. Bu çalışma bu bozuklukların tanı yöntemlerini, tedavi planlarını ve prognozunu değerlendirmeyi amaçlamaktadır.
Metodlar
Bu çalışmada Ocak 2018-Ocak 2021 yılları arasında fetal aritmi tanısı alan 28 fetusun kayıtları retrospektif olarak değerlendirilmiştir.
Sonuç
1254 gebe kadının 28'inde (%2,2) fetal aritmi tespit edildi. Hastaların 21/28'inde (%75) düzensiz ritim, 4/28'inde (%14,2) supraventriküler taşikardi, 3/28'inde (%10,7) fetal av blok görüldü. Fetusta taşikardisi olan tüm gebeler hastaneye yatırılarak uygun dozda digoksin başlandı. Atriyal taşikardi/fibriloflutter olan ¼ fetusta ; sotalol eklendi ve kombine tedaviye başlandı. İnatçı taşikardisi olan diğer fetüse ise hız kontrolü sağlamak amacıyla sotalol de eklendi. Atriyal fibriloflutter olan yenidoğana doğumda kardiyoversiyon uygulandı. Bu yenidoğana propafenon propranolol amiodaron üçlü kombinasyonu başlanarak taşikardi kontrol altına alındı. Taşikardisi olan hastalarda intrauterin ölüm ve postnatal dönemde mortalite görülmedi. Bir hastada doğumdan sonra WPW sendromu tespit edildi. WPW sendromu ve atriyal fibriloflutter hastaların da en az iki yıl uzun süreli medikal tedavi planlandı. AV tam bloklu ve kompleks konjenital kalp hastalığı olan 2 fetüs intrauterin dönemde kaybedildi. Diğer AV blok olan fetüsün neonatal lupusu vardı ve doğum sonrası dönemde kalp yetmezliği nedeniyle kaybedildi.
Tartışma
Fetal ekokardiyografi Doppler yaklaşımı ile fetal kalp ritim bozuklukları doğum öncesi dönemde tespit edilebilmektedir. Fetüsün sağlık durumuna göre antiaritmik ilaçlar düşünülebilir. Etiyolojinin aydınlatılmasında annenin diyeti ve lupus antikorları dikkate alınmalıdır.

Keywords

Fetal aritmi, fetal ekokardiyografi, prenatal tanı, fetal taşikardi.

Regional Fetal Arrhythmia Screening Results and Postnatal Follow-up Current Results In a Single Center

Abstract

Background/Aims
Fetal arrhythmias are one of the challenging diseases in pregnancies and have an important impress on fetal health. This study aims to evaluate diagnosis methods, treatment plans, and prognosis for these disorders.
Methods
Fetuses diagnosed with fetal arrhythmia between January 2018 and January 2021 were retrospectively screened from hospital records and 28 fetuses were identified.
Results
Fetal arrhythmia was detected in 28 fetuses out of 1254 pregnant women (2.2%). Irregular rhythm was observed in 21/28(75%) of the fetuses, supraventricular tachycardia in 4/28 fetuses (14.2%), and fetal atrioventricular(AV) block in 3/28 fetuses (10.7%). All fetuses with tachycardia were hospitalized and digoxin was started at the appropriate dose. In 1/4 of fetuses with atrial tachycardia/fibriloflutter; sotalol was added and combined treatment was started. In the other fetus with persistent tachycardia, sotalol was also added to achieve the rate control. Cardioversion was applied to the newborn who had atrial fibriloflutter at birth. In this newborn, a propafenone propranolol amiodarone triple combination was started and tachycardia was controlled. There was neither intrauterine death nor mortality in the postnatal period in patients with tachycardia. WPW syndrome was detected in one patient after birth. Prolonged medical treatment for at least two years is planned in patients with WPW syndrome and atrial fibriloflutter.2 fetuses with complete AV block and complex congenital heart diseases had died in the intrauterine period. The other fetus with AV block had neonatal lupus and this patient also died due to heart failure in the postnatal period.
Conclusions
Fetal heart rhythm disorders can be detected prenatally with fetal echocardiography Doppler approach. Anti-arrhythmic drugs could be considered depending on the fetuses’ well-being. The mother's diet, and lupus antibodies should be considered in elucidating the etiology.

Keywords

Fetal arrhythmias, fetal echocardiography, prenatal diagnosis, fetal tachycardia

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