Fetal arrhythmias case series: Experiences from a fetal screening center in Taiwan.

OBJECTIVE: Fetal arrhythmias are common and in rare cases can be associated with severe mortality and morbidity. Most existing articles are focused on classification of fetal arrhythmias in referral centers. Our main objective was to analyze types, clinical characteristics, and outcomes for arrhythmia cases in general practice. CASE REPORT: We retrospectively reviewed a case series of fetal arrhythmias in a fetal medicine clinic between September 2017 and August 2021. FETAL ARRHYTHMIAS IN OUR SAMPLE PRESENTED BY: Ectopies (86%, n = 57), bradyarrhythmias (11%, n = 7), and tachyarrhythmias (3%, n = 2). One tachyarrhythmia case was associated with Ebstein's anomaly. Two cases of second-degree AV block received transplacental fluorinated steroid therapy with recovery of fetal cardiac rhythm in later gestation. One case of complete AV block developed hydrops fetalis. CONCLUSION: Detection and careful stratification of fetal arrhythmias in obstetric screening is crucial. While most arrhythmias are benign and self-limited, some require prompt referral and timely intervention.

Associated factors with parental pregnancy decision-making and use of consultation after a prenatal congenital heart disease diagnosis.

BACKGROUND: Prenatal diagnosis of congenital heart disease (CHD) often leads affected families to experience psychological stress. Pediatric cardiology consultation is important in providing parents with sufficient information and reducing their anxiety to make an informed pregnancy decision. Involving a fetal nurse coordinator may optimize fetal anomaly care. Our study aimed to identify factors associated with parental decision-making for choosing to use pediatric cardiology consultations and pregnancy termination. METHODS: From September 2017 to December 2018, all fetal CHD cases diagnosed in the second trimester from a primary screening clinic in Taiwan were included (n = 145). Univariate and multivariate logistic regression were performed to analyze maternal, fetal, and medical factors for predictors of parental decisions for consultation use and pregnancy termination. RESULTS: Acceptance for fetal nurse coordinator care and pediatric cardiology consultation were 84.8% (n = 123) and 83.4% (n = 121), respectively. Predictors for termination of pregnancy included the following: multiple anomalies (OR: 10.6; 95% CI: 3.6-35.7), chromosomal/genetic abnormalities (OR: 20.2; 95% CI: 3.1-395.8), severe CHDs (OR: 9.8; 95% CI: 4.3-23.4), CHDs that required surgery (OR: 32.4; 95% CI: 11.4-117.8), and physiological single-ventricle (OR: 47.3; 95% CI: 12.4-312.5). Parents who had pediatric cardiology counseling were less likely to terminate the pregnancy (OR: 0.1; 95% CI: 0.0-0.7). Parents with fetal diagnosis having multiple anomalies (OR: 0.2; 95% CI: 0.1-0.7) or chromosomal/genetic abnormalities (OR: 0.1; 95% CI: 0.03-0.9) were less likely to make use of cardiology consultation. Parents who accepted fetal nurse coordinator care were more likely to have pediatric cardiology consultation before pregnancy decision (OR: 149.5, 95% CI: 37.8-821.5). CONCLUSIONS: Anomaly complexity appeared to be a strong predictor for termination of pregnancy beyond non-acceptability of prenatal cardiology consultation. Prenatal cardiology counseling may help support the parental decision to continue with the pregnancy. Incorporation of a fetal nurse coordinator care into the multidisciplinary fetal medicine team improved the acceptability of prenatal consultation.