Maternal steroid therapy for fetuses with immune-mediated complete atrioventricular block: a systematic review and meta-analysis

Abstract

The findings from this systematic review do not suggest a potential positive contribution of antenatal steroid therapy in improving the outcome of fetuses with immune CAVB.

Maternal steroid therapy for fetuses with second‐degree immune‐mediated congenital atrioventricular block: a systematic review and meta‐analysis

“…Early gestational age at diagnosis, low ventricular rate and the presence of fetal hydrops have been reported to be the major determinants of perinatal outcome in fetuses affected by immune‐mediated AVB . Despite this, optimal management once AVB has been detected in utero has yet to be established .…”

Use of antenatal fluorinated corticosteroids in management of congenital heart block: Systematic review and meta-analysis

“…In this meta-analysis, fluorinated steroids were not superior to no-treatment except in the incidence of downgrading of CHB after initiation of treatment. However, some reviews have reported that transplacental steroid rarely reverse complete CHB, the fact that may explain the lack of improvement of outcomes despite steroid downgrading effect [57,58]. In addition, our results raise serious concern on the risk of oligohydramnios and IUGR, particularly as regimens described in these studies include high dose and/or prolonged use of corticosteroid.…”

Prenatal diagnosis and management of congenital complete heart block

“…A large multinational, multicenter retrospective study of patients with second degree heart block or CCHB found no difference in mortality between those treated with corticosteroids ± beta stimulation versus untreated populations (Eliasson et al, ). Additionally, a recent meta‐analysis comparing data from 8 studies for a total of 162 fetuses found no difference in mortality or pacemaker implantation in steroid‐treated versus nontreated patients (Ciardulli et al, ). Despite these generally negative findings, corticosteroid ± beta stimulation may prove to be advantageous in certain CCHB subsets such as those with fetal hydrops (Ciardulli et al, ) or those treated during emergent CCHB (Cuneo et al, ).…”

“…Additionally, a recent meta‐analysis comparing data from 8 studies for a total of 162 fetuses found no difference in mortality or pacemaker implantation in steroid‐treated versus nontreated patients (Ciardulli et al, ). Despite these generally negative findings, corticosteroid ± beta stimulation may prove to be advantageous in certain CCHB subsets such as those with fetal hydrops (Ciardulli et al, ) or those treated during emergent CCHB (Cuneo et al, ). Thus, ongoing investigation is important to identify CCHB patients who may possibly benefit from optimal pharmacotherapy.…”