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Foetal therapy, what works? An overview

Published online by Cambridge University Press:  28 August 2014

Mats Mellander  and
Helena Gardiner
Mats Mellander*
Affiliation:
The Queen Silvia Children’s Hospital, Sahlgrenska University Hospital, Göteborg, Sweden
Helena Gardiner
Affiliation:
Texas Fetal Center, University of Texas, Houston, Texas, United States of America
*
Correspondence to: Dr M. Mellander, MD, PhD, Department of Paediatric Cardiology, The Queen Silvia Children’s Hospital, Sahlgrenska University Hospital, Göteborg, Sweden. Tel: +00 463 134 346 59; Fax: +00 463 184 5029; E-mail: [email protected]
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Abstract

The update course in foetal cardiology held by the Fetal Working Group of the Association for European Paediatric and Congenital Cardiology in Istanbul in May 2012 included a session on foetal cardiac therapy. In the introductory overview to this symposium, we critically examine the level of evidence supporting or refuting proposed foetal cardiac therapies including transplacental treatment of foetal tachyarrhythmias, steroid treatment in foetal atrioventricular block, and foetal aortic valvuloplasty. In summary, the evidence for the efficiency and safety of currently available foetal cardiac therapies is low, with no therapy based on a randomised controlled trial. Transplacental treatment of foetal tachycardia is generally accepted as effective and safe, based on extensive and widespread clinical experience; however, there is no consensus on which drugs are the most effective in different electrophysiological situations. Randomised studies may be able to resolve this, but this is complicated because tachyarrhythmias are relatively rare conditions, the foetus is not accessible for direct treatment, and it is the healthy mother who accepts treatment she does not need on behalf of her foetus. The indications for steroid treatment in foetal atrioventricular block and for foetal valvuloplasty are even more controversial. Although randomised trials would be desirable, the practical issues of recruiting sufficient sample sizes and controlling for variation in practice across multiple sites is not to be underestimated. Multicentre registries, analysed free of bias, may be an alternative way to improve the evidence base of foetal cardiac therapy.

Keywords

Foetal therapiesfoetal heartevidence based medicine
Type
Original Article
Information
Cardiology in the Young , Volume 24 , Issue S2: Fetal cardiovascular medicine: current perspectives and future hopes , October 2014 , pp. 36 - 40
Copyright
© Cambridge University Press 2014 

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