Management in maternal autoantibody-mediated clinical foetal myocardial disease

Julia Murlewska; Krzysztof Preis; Maciej Słodki; Iwona Strzelecka; Elżbieta Smolewska; Maria Respondek-Liberska

doi:10.5114/pcard.2019.91001

eISSN: 2449-6731
ISSN: 2449-6723

Prenatal Cardiology

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abstract:

Review paper

Management in maternal autoantibody-mediated clinical foetal myocardial disease

Julia Murlewska

^{1, 2}

,

Krzysztof Preis

^{2, 3}

,

Maciej Słodki

^{1, 2, 4}

,

Iwona Strzelecka

^{1, 5}

,

Elżbieta Smolewska

⁶

,

Maria Respondek-Liberska

^{1, 5}

Department of Prenatal Cardiology, Polish Mother’s Memorial Hospital Research Centre, Lodz, Poland
Board of the Polish Prenatal Cardiology Society, Poland
Department of Obstetrics & Gynaecology, Medical University of Gdansk, Poland
Institute of Health Sciences, The State School of Higher Professional Education in Plock, Poland
Department for Foetal Malformations and Diagnoses & Prevention, Medical University of Lodz, Poland
Department of Paediatric Rheumatology, Institute of Paediatrics, Medical University of Lodz, Poland

Prenat Cardio 2019; 9(1): 5-11

DOI: https://doi.org/10.5114/pcard.2019.91001

Online publish date: 2019/12/19

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Our group presents our reflections, based on the current literature, concerning the obstetric and rheumatologic management of the foetus identified with clinical myocardial disease mediated by maternal autoantibodies (MAb). The European League Against Rheumatism (EULAR) have recommended the use of hydroxychloroquine (HCQ) during asymptomatic lupus pregnancies since 2007. Foetal echocardiography is indicated if there is suspected foetal dysrhythmia or myocarditis, especially in the involvement of positive maternal anti-Ro/SSA or anti-La/SSB antibodies weekly from 16 weeks of gestation upwards. The obstetric management should be guided by the degree of cardiac failure on foetal echocardiography. Foetal therapy with steroids, intravenous immunoglobulin (IVIG), and plasmapheresis should be reasonably introduced in the lowest effective doses for the shortest duration of time. The aim of the management should be to reverse incomplete heart block and other MAb-mediated foetal myocardial disease, presumably induced due to ongoing inflammation. In irreversible cases the treatment should be stopped, due to its possible maternal side effects. Delivery of the affected newborn should be performed in a tertiary centre, and pacemaker implantation might be an option for neonates.

keywords:

Management in maternal autoantibody-mediated clinical foetal myocardial disease

Julia Murlewska 1, 2 , Krzysztof Preis 2, 3 , Maciej Słodki 1, 2, 4 , Iwona Strzelecka 1, 5 , Elżbieta Smolewska 6 , Maria Respondek-Liberska 1, 5

foetal echocardiography, congenital heart block, foetal lupus syndrome, foetal myocarditis, foetal cardiomyopathy

Julia Murlewska

^{1, 2}

,

Krzysztof Preis

^{2, 3}

,

Maciej Słodki

^{1, 2, 4}

,

Iwona Strzelecka

^{1, 5}

,

Elżbieta Smolewska

⁶

,

Maria Respondek-Liberska

^{1, 5}