nach oben

Die Gynäkologie

Erschienen in:

22.12.2021 | Tachykarde Herzrhythmusstörungen | Leitthema

Fetale Arrhythmien – ein Update

verfasst von: Prof. Dr. Ulrich Gembruch

Erschienen in: Die Gynäkologie | Ausgabe 1/2022

Einloggen, um Zugang zu erhalten

Zusammenfassung

Länger anhaltende Arrhythmien werden bei 1–2 % der Feten nachgewiesen. Differenziert werden fetale Arrhythmien mittels M‑mode- und Doppler-Echokardiographie. Überwachung und Therapie sind der vorliegenden Arrhythmie anzupassen. Bei Tachyarrhythmien werden transplazentar Digoxin, Flecainid, Sotalol und Amiodaron eingesetzt, wobei Flecainid bei atrioventrikulären Reentry-Tachykardien mehr und mehr primär eingesetzt wird. Beim inflammatorisch bedingten kompletten AV(atrioventrikulären)-Block (congenital complete heart block, CCHB) durch maternale Anti-SSA/Ro-Antikörper ist eine generelle transplazentare Behandlung mit hochdosierten fluorierten Kortikosteroiden zur Eindämmung einer begleitenden Myokarditis aufgrund des Nebenwirkungsprofils nicht indiziert; sie ist allenfalls bei Feten mit Zeichen kardialer Dysfunktion und kardialer Fibrose zu erwägen. Zur Prävention sollte im Hochrisikokollektiv (Wiederholungsrisiko bei vorherigem Kind mit CCHB 16–19 %) die tägliche Gabe von 400 mg Hydroxychloroquin (HCQ) bereits vor der 10. Schwangerschaftswoche (SSW) erfolgen, wodurch das Risiko halbiert werden kann. Derzeit nicht indiziert ist eine generelle HCQ bei allen Schwangeren mit nachweisbaren Anti-SSA/Ro-Antikörpern zwecks Prävention, da aufgrund des geringen Risikos von 1–2 % die „number needed to treat“ (NNT) 100+ beträgt und relevante kardiale Ereignisse aufgrund der HCQ-bedingten QT-Zeit-Verlängerung möglich erscheinen. Die lange Zeit empfohlene sehr aufwendige wöchentlich echokardiographische Messung der fetalen AV-Zeit mit dem Ziel, einen AV-Block I. Grades zu erkennen und durch Behandlung mit Dexamethason das Auftreten einer CCHB zu verhindern, hat sich mittlerweile als ineffektiv erweisen.

Alsaied T, Baskar S, Fares M et al (2017) First-line antiarrhythmic transplacental treatment for fetal tachyarrhythmia: a systematic review and meta-analysis. J Am Heart Assoc 6:e7164PubMedPubMedCentralCrossRef

Andersson NW, Skov L, Andersen JT (2020) Fetal safety of chloroquine and hydroxychloroquine use during pregnancy: a nationwide cohort study. Rheumatology 60:2317–2326CrossRef

Bar-Cohen Y, Loeb GE, Pruetz JD et al (2015) Preclinical testing and optimization of a novel fetal micropacemaker. Heart Rhythm 12:1683–1690PubMedPubMedCentralCrossRef

Bartin R, Maltret A, Nicloux M et al (2021) Outcomes of sustained fetal tachyarrhythmias after transplacental treatment. Heart Rhythm 2:160–167CrossRef

Baschat AA, Gembruch U, Knöpfle G, Hansmann M (1999) First-trimester fetal heart block: a marker for cardiac anomaly. Ultrasound Obstet Gynecol 14:311–314PubMedCrossRef

Bérard A, Sheehy O, Zhao JP et al (2021) Chloroquine and hydroxychloroquine use during pregnancy and the risk of adverse pregnancy outcomes using real-world evidence. Front Pharmacol 12:722511PubMedPubMedCentralCrossRef

Berg C, Geipel A, Smrcek J et al (2003) Prenatal diagnosis of cardiosplenic syndromes: a 10-year experience. Ultrasound Obstet Gynecol 22:451–459PubMedCrossRef

Berg C, Geipel A, Kohl T et al (2005) Atrioventricular block detected in fetal life: associated anomalies and potential prognostic markers. Ultrasound Obstet Gynecol 26:4–15PubMedCrossRef

Berg C, Geipel A, Kamil D et al (2005) The syndrome of left isomerism: sonographic findings and outcomes in prenatally diagnosed cases. J Ultrasound Med 24:921–931PubMedCrossRef

10.

Berg C, Gottschalk I, Geipel A, Gembruch U (2013) Diagnosis and therapy of fetal arrhythmias 1—methods of rhythm diagnosis, extrasystole and bradyarrhythias. Ultraschall Med 34:114–127PubMedCrossRef

11.

Berg C, Gottschalk I, Gembruch U, Geipel A (2013) Diagnosis and therapy of fetal arrhythmia part 2—Fetal tachyarrhythmias and their intrauterine treatment. Ultraschall Med 34:322–331PubMedCrossRef

12.

Bergman G, Eliasson H, Mohlkert LA et al (2012) Progression to first-degree heart block in preschool children exposed in utero to maternal anti-SSA/Ro52 autoantibodies. Acta Paediatr 101:488–493PubMedCrossRef

13.

Ciobanu AM, Dumitru AE, Gica N et al (2020) Benefits and risks of IgG transplacental transfer. Diagnostics 10:583PubMedCentralCrossRef

14.

Ciardulli A, D’Antonio F, Magro-Malosso ER et al (2018) Maternal steroid therapy for fetuses with second-degree immune-mediated congenital atrioventricular block: a systematic review and meta-analysis. Acta Obstet Gynecol Scand 97:787–794PubMedCrossRef

15.

Clur SB, Vink AS, Etheridge SP et al (2018) Left ventricular isovolumetric relaxation time is prolonged in fetal long-QT syndrome. Circ Arrhythm Electrophysiol 11:e5797PubMedCrossRef

16.

Cuneo BF (2019) Fetal bradycardia. In: Yagel S, Silverman NH, Gembruch U (Hrsg) Fetal cardiology: embryology, genetics, physiology, echocardiographic evaluation, diagnosis, and perinatal management of cardiac diseases. CRC Press, Taylor & Francis Group, Boca Raton, S 513–529

17.

Cuneo BF, Bitant S, Strasburger JF et al (2019) Assessment of atrioventricular conduction by echocardiography and magnetocardiography in normal and anti-Ro/SSA-antibody-positive pregnancies. Ultrasound Obstet Gynecol 54:625–633PubMedPubMedCentralCrossRef

18.

Cuneo BF, Buyon JP (2019) Keeping upbeat to prevent the heartbreak of anti-Ro/SSA pregnancy. Ultrasound Obstet Gynecol 54:7–9PubMedCrossRef

19.

Cuneo BF, Etheridge SP, Horigome H et al (2013) Arrhythmia phenotype during fetal life suggests long-QT syndrome genotype: risk stratification of perinatal long-QT syndrome. Circ Arrhythm Electrophysiol 6:946–951PubMedPubMedCentralCrossRef

20.

Cuneo BF, Sonesson SE, Levasseur S et al (2018) Home monitoring for fetal heart rhythm during anti-Ro pregnancies. J Am Coll Cardiol 72:1940–1951PubMedCrossRef

21.

Cuneo BF, Strasburger JF, Yu S et al (2013) In utero diagnosis of long QT syndrome by magnetocardiography. Circulation 128:2183–2191PubMedCrossRef

22.

Eliasson H, Sonesson SE, Sharland G et al (2011) Isolated atrioventricular block in the fetus: a retrospective, multinational, multicenter study of 175 patients. Circulation 124:1919–1926PubMedCrossRef

23.

Fredi M, Andreoli L, Bacco B et al (2019) First report of the Italian registry on immune-mediated congenital heart block (Lu.Ne Registry). Front Cardiovasc Med 6:11PubMedPubMedCentralCrossRef

24.

Friedman DM, Kim MY, Copel JA et al (2009) Prospective evaluation of fetuses with autoimmune-associated congenital heart block followed in the PR Interval and Dexamethasone Evaluation (PRIDE) Study. Am J Cardiol 103:1102–1106PubMedPubMedCentralCrossRef

25.

Friedman DM, Kim M, Costedoat-Chalumeau N et al (2020) Electrocardiographic QT intervals in infants exposed to hydroxychloroquine throughout gestation. Circ Arrhythm Electrophysiol 13:e8686PubMedPubMedCentralCrossRef

26.

Friedman DM, Llanos C, Izmirly PM et al (2010) Evaluation of fetuses in a study of intravenous immunoglobulin as preventive therapy for congenital heart block: Results of a multicenter, prospective, open-label clinical trial. Arthritis Rheum 62:1138–1146PubMedPubMedCentralCrossRef

27.

Gembruch U (2019) Fetal tachyarrhythmia. In: Yagel S, Silverman N, Gembruch U (Hrsg) Fetal cardiology, 3. Aufl. CRC Press, Taylor & Francis, Boca Raton, S 530–547

28.

Gembruch U, Bald R, Hansmann M (1990) Die farbkodierte M‑mode-Doppler-Echokardiographie bei der Diagnostik fetaler Arrhythmien. Geburtshilfe Frauenheilkd 50:286–290PubMedCrossRef

29.

Gembruch U, Hansmann M, Redel DA, Bald (1988) Intrauterine therapy of fetal tachyarrhythmias: intraperitoneal administration of antiarrhythmic drugs to the fetus in fetal tachyarrhythmias with severe hydrops fetalis. J Perinat Med 16:39–44PubMedCrossRef

30.

Gembruch U, Hansmann M, Redel DA et al (1989) Fetal complete heart block: antenatal diagnosis, significance and management. Eur J Obstet Gynecol Reprod Biol 31:9–22PubMedCrossRef

31.

Gembruch U, Krapp M, Baumann P (1995) Changes of venous blood flow velocity waveforms in fetuses with supraventricular tachycardia. Ultrasound Obstet Gynecol 5:394–399PubMedCrossRef

32.

Gembruch U, Krapp M, Germer U, Baumann P (1999) Venous Doppler in the sonographic surveillance of fetuses with supraventricular tachycardia. Eur J Obstet Gynecol Reprod Biol 84:187–192PubMedCrossRef

33.

Gembruch U, Manz M, Bald R et al (1989) Repeated intravascular treatment with amiodarone in a fetus with refractory supraventricular tachycardia and hydrops fetalis. Am Heart J 118:1335–1338PubMedCrossRef

34.

Gembruch U, Redel DA, Bald R, Hansmann M (1993) Longitudinal study in 18 cases of fetal supraventricular tachycardia: Doppler-echocardiographic findings and pathophysiological implications. Am Heart J 125:1290–1301PubMedCrossRef

35.

Gest AL, Bair DK, Vander Straten MC (1993) Thoracic duct lymph flow in fetal sheep with increased venous pressure from electrically induced tachycardia. Biol Neonate 64:325–330PubMedCrossRef

36.

Gest AL, Martin CG, Moise AA, Hansen TN (1990) Reversal of venous blood flow with atrial tachycardia and hydrops in fetal sheep. Pediatr Res 28:223–226PubMedCrossRef

37.

Groves AMM, Allan LD, Rosenthal E (1995) Therapeutic trial of sympathomimetics in three cases of complete heart block in the fetus. Circulation 92:3394–3396PubMedCrossRef

38.

Guettrot-Imbert G, Cohen L, Fermont L et al (2011) A new presentation of neonatal lupus: 5 cases of isolated mild endocardial fibroelastosis associated with maternal anti-Ro/SSA and anti-La/SSB antibodies. J Rheumatol 38:378–386PubMedCrossRef

39.

Hansmann M, Gembruch U, Bald R et al (1991) Fetal tachyarrhythmias: transplacental and direct treatment of the fetus—a report of sixty fetuses. Ultrasound Obstet Gynecol 1:162–170PubMedCrossRef

40.

van der Heijden LB, Oudijk MA, Manten GT et al (2013) Sotalol as first-line treatment for fetal tachycardia and neonatal follow-up. Ultrasound Obstet Gynecol 42:285–293PubMedCrossRef

41.

Hill GD, Kovach JR, Saudek DE et al (2017) Transplacental treatment of fetal tachycardia: a systematic review and meta-analysis. Prenat Diagn 37:1076–1083PubMedCrossRef

42.

Ho SY, Esscher E, Anderson RH, Michaelsson M (1986) Anatomy of congenital complete heart block and relation to maternal anti-Ro-antibodies. Am J Cardiol 58:291–294PubMedCrossRef

43.

Ho SY, Fagg N, Anderson RH et al (1992) Disposition of the atrioventricular conduction tissues in the heart with isomerism of the atrial appendages: its relation to congenital complete heart block. J Am Coll Cardiol 20:904–910PubMedCrossRef

44.

Hutter D, Silverman ED, Jaeggi ET (2010) The benefits of transplacental treatment of isolated congenital complete heart block associated with maternal anti-Ro/SSA antibodies: a review. Scand J Immunol 72:235–241PubMedCrossRef

45.

Huybrechts KF, Bateman BT, Zhu Y et al (2021) Hydroxychloroquine early in pregnancy and risk of birth defects. Am J Obstet Gynecol 224:290.e1–290.e22CrossRef

46.

Izmirly PM, Costedoat-Chalumeau N, Pisoni CN et al (2012) Maternal use of hydroxychloroquine is associated with a reduced risk of recurrent anti-SSA/Ro-antibody-associated cardiac manifestations of neonatal lupus. Circulation 126:76–82PubMedPubMedCentralCrossRef

47.

Izmirly P, Kim M, Friedman DM et al (2020) Hydroxychloroquine to prevent recurrent congenital heart block in fetuses of anti-SSA/Ro-positive mothers. J Am Coll Cardiol 76:292–302PubMedPubMedCentralCrossRef

48.

Izmirly PM, Saxena A, Sahl SK et al (2016) Assessment of fluorinated steroids to avert progression and mortality in anti-SSA/Ro-associated cardiac injury limited to the fetal conduction system. Ann Rheum Dis 75:1161–1165PubMedCrossRef

49.

Jaeggi ET (2019) Electrophysiology for the perinataologist. In: Yagel S, Silverman NH, Gembruch U (Hrsg) Fetal cardiology: embryology, genetics, physiology, echocardiographic evaluation, diagnosis, and perinatal management of cardiac diseases. CRC Press, Taylor & Francis Group, Boca Raton, S 504–514

50.

Jaeggi ET, Carvalho JS, De Groot E et al (2011) Comparison of transplacental treatment of fetal supraventricular tachyarrhythmias with digoxin, flecainide, and sotalol: results of a nonrandomized multicenter study. Circulation 124:1747–1754PubMedCrossRef

51.

Jaeggi ET, Fouron JC, Silverman ED et al (2004) Transplacental fetal treatment improves the outcome of prenatally diagnosed complete atrioventricular block without structural heart disease. Circulation 110:1542–1548PubMedCrossRef

52.

Jaeggi ET, Hornberger LK, Smallhorn JF, Fouron JC (2005) Prenatal diagnosis of complete atrioventricular block associated with structural heart disease: combined experience of two tertiary care centers and review of the literature. Ultrasound Obstet Gynecol 26:16–21PubMedCrossRef

53.

Jaeggi E, Laskin C, Hamilton R et al (2010) The importance of the level of maternal anti-Ro/SSA antibodies as a prognostic marker of the development of cardiac neonatal lupus erythematosus: a prospective study of 186 antibody-exposed fetuses and infants. J Am Coll Cardiol 55:2778–2784PubMedCrossRef

54.

Jaeggi ET, Silverman ED, Laskin C et al (2011) Prolongation of the atrioventricular conduction in fetuses exposed to maternal anti-Ro/SSA and anti-La/SSB antibodies did not predict progressive heart block. A prospective observational study on the effects of maternal antibodies on 165 fetuses. J Am Coll Cardiol 57:1487–1492PubMedCrossRef

55.

Jobe AH, Goldenberg RL (2018) Antenatal corticosteroids: an assessment of anticipated benefits and potential risks. Am J Obstet Gynecol 219:62–74PubMedCrossRef

56.

Jouannic JM, Delahaye S, Fermont L et al (2003) Fetal supraventricular tachycardia: a role for amiodarone as second-line therapy. Prenat Diagn 23:152–156PubMedCrossRef

57.

Kan N, Silverman ED, Kingdom J et al (2017) Serial echocardiography for immune-mediated heart disease in the fetus: results of a risk-based prospective surveillance strategy. Prenat Diagn 37:375–382PubMedCrossRef

58.

Ko JK, Deal BJ, Strasburger JF et al (1992) Supraventricular tachycardia mechanisms and their age distribution in pediatric patients. Am J Cardiol 69:1028–1031PubMedCrossRef

59.

Kothari DS, Skinner JR (2006) Neonatal tachycardias: an update. Arch Dis Child Fetal Neonatal Ed 91:136–144CrossRef

60.

Krapp M, Baschat AA, Gembruch U et al (2002) Flecainide in the intrauterine treatment of fetal suparventricular tachycardia. Ultrasound Obstet Gynecol 19:158–164PubMedCrossRef

61.

Krapp M, Gembruch U, Baumann P (1997) Venous blood flow pattern suggesting tachycardia-induced cardiomyopathy in the fetus. Ultrasound Obstet Gynecol 10:32–40PubMedCrossRef

62.

Krapp M, Kohl T, Simpson JM et al (2003) Review of diagnosis, treatment, and outcome of fetal atrial flutter compared with supraventricular tachycardia. Heart 89:913–917PubMedPubMedCentralCrossRef

63.

Krummholz A, Gottschalk I, Geipel A et al (2021) Prenatal diagnosis, associated findings and postnatal outcome in fetuses with congenitally corrected transposition of the great arteries. Arch Gynecol Obstet 303:1469–1481PubMedCrossRef

64.

Lazzerini PE, Laghi-Pasini F, Boutjdir M, Capecchi PL (2021) Anti-Ro/SSA antibodies and the autoimmune long-QT syndrome. Front Med 8:730161CrossRef

65.

Lin PH, Wu HH, Tsai HD, Hsieh CT (2016) Successful treatment of atrial flutter by repeated intraperitoneal and intra-amniotic injections of amiodarone in a fetus with hydrops. Taiwan J Obstet Gynecol 55:434–436PubMedCrossRef

66.

Limaye MA, Buyon JP, Cuneo BF, Mehta-Lee SS (2020) A review of fetal and neonatal consequences of maternal systemic lupus erythematosus. Prenat Diagn 40:1066–1076PubMedCrossRef

67.

Michaelsson M, Engle MA (1972) Congenital complete heart block: an international study of the natural history. Cardiovasc Clin 4:85–101PubMed

68.

Mitchell JL, Cuneo BF, Etheridge SP et al (2012) Fetal heart rate predictors of long QT syndrome. Circulation 126:2688–2695PubMedCrossRef

69.

Miyoshi T, Maeno Y, Hamasaki T et al (2019) Antenatal therapy for fetal supraventricular tachyarrhythmias: multicenter trial. J Am Coll Cardiol 74:874–885PubMedCrossRef

70.

Mofors J, Eliasson H, Ambrosi A et al (2019) Comorbidity and long-term outcome in patients with congenital heart block and their siblings exposed to Ro/SSA autoantibodies in utero. Ann Rheum Dis 78:696–703PubMedCrossRef

71.

Naheed ZJ, Strasburger JF, Deal BJ et al (1996) Fetal tachycardia: mechanisms and predictors of hydrops fetalis. J Am Coll Cardiol 27:1736–1740PubMedCrossRef

72.

Narang K, Rose CH, Johnson JN et al (2020) Rare case of fetal permanent junctional reciprocating tachycardia refractory to prenatal antiarrhythmic therapy. Mayo Clin Proc Innov Qual Outcomes 4:810–814PubMedPubMedCentralCrossRef

73.

Phoon CKL, Kim MY, Buyon JP, Friedman DM (2012) Finding the “PR-fect” solution: what is the best tool to measure fetal cardiac PR intervals for the detection and possible treatment of early conduction disease? Congenit Heart Dis 7:349–360PubMedPubMedCentralCrossRef

74.

Pisoni CN, Brucato A, Ruffatti A et al (2010) Failure of intravenous immunoglobulin to prevent congenital heart block: findings of a multicenter, prospective, observational study. Arthritis Rheum 62:1147–1152PubMedCrossRef

75.

Pruetz JD, Miller JC, Loeb GE et al (2019) Prenatal diagnosis and management of congenital complete heart block. Birth Defects Res 111:380–388PubMedPubMedCentralCrossRef

76.

Rein AJJT, O’Donnell C, Geva T et al (2002) Use of tissue velocity imaging in the diagnosis of fetal cardiac arrhythmias. Circulation 106:1827–1833PubMedCrossRef

77.

Saito M, Silverman E, Golding F et al (2021) Effects of transplacental dexamethasone therapy on fetal immune-mediated complete heart block. Fetal Diagn Ther 48:183–188PubMedCrossRef

78.

Sethi N, Funamoto K, Ingbar C et al (2020) Noninvasive fetal electrocardiography in the diagnosis of long QT syndrome: a case series. Fetal Diagn Ther 47:711–716PubMedCrossRef

79.

Shokrzadeh A, Maltret A, Morel N et al (2021) Longitudinal analysis of fetal ventricular rate for risk stratification in immune congenital heart block. Fetal Diagn Ther 48:1–8CrossRefPubMed

80.

Spinale FG, Tanaka R, Crawford FA, Zile MR (1992) Changes in myocardial blood flow during development of and recovery from tachycardia-induced cardiomyopathy. Circulation 85:717–729CrossRef

81.

Sonesson SE, Ambrosi A, Wahren-Herlenius M (2019) Benefits of fetal echocardiographic surveillance in pregnancies at risk of congenital heart block: Single-center study of 212 anti-Ro52-positive pregnancies. Ultrasound Obstet Gynecol 54:87–95PubMedCrossRef

82.

Sonesson SE, Salomonsson S, Jacobsson LA et al (2004) Signs of first-degree heart block occur in one-third of fetuses of pregnant women with anti-SSA/Ro 52-kd antibodies. Arthritis Rheum 50:1253–1261PubMedCrossRef

83.

Sridharan S, Sullivan I, Tomek V et al (2016) Flecainide versus digoxin for fetal supraventricular tachycardia: comparison of two drug treatment protocols. Heart Rhythm 13:1913–1919PubMedCrossRef

84.

Stevens DC, Hilliard JK, Schreiner RL et al (1982) Supraventricular tachycardia with edema, ascites, and hydrops in fetal sheep. Am J Obstet Gynecol 142:316–322PubMedCrossRef

85.

Stirnemann J, Maltret A, Haydar A et al (2018) Successful in utero transesophageal pacing for severe drug-resistant tachyarrhythmia. Am J Obstet Gynecol 219:320–325PubMedCrossRef

86.

Strand S, Strasburger JF, Cuneo BF, Wakai RT (2020) Complex and novel arrhythmias precede stillbirth in fetuses with de novo long QT syndrome. Circ Arrhythm Electrophysiol 13:e8082PubMedPubMedCentralCrossRef

87.

Strand SA, Strasburger JF, Wakai RT (2019) Fetal magnetocardiogram waveform characteristics. Physiol Meas 40:35002PubMedPubMedCentralCrossRef

88.

Strasburger JF, Cuneo BF, Michon MM et al (2004) Amiodarone therapy for drug-refractory fetal tachycardia. Circulation 109:375–379PubMedCrossRef

89.

Strasburger JF, Wacker-Gussmann A (2020) Congenital heart block in subsequent pregnancies of SSA/Ro-positive mothers: cutting recurrence in half. J Am Coll Cardiol 76:303–305PubMedPubMedCentralCrossRef

90.

Strizek B, Berg C, Gottschalk I et al (2016) High-dose flecainide is the most effective treatment of fetal supraventricular tachycardia. Heart Rhythm 13:1283–1288PubMedCrossRef

91.

Trucco SM, Jaeggi E, Cuneo B et al (2011) Use of intravenous gamma globulin and corticosteroids in the treatment of maternal autoantibody-mediated cardiomyopathy. J Am Coll Cardiol 57:715–723PubMedCrossRef

92.

Veduta A, Panaitescu AM, Ciobanu AM et al (2021) Treatment of fetal arrhythmias. J Clin Med 10:2510PubMedPubMedCentralCrossRef

93.

Wakai RT, Strasburger JF, Li Z et al (2003) Magnetocardiographic rhythm patterns at initiation and termination of fetal supraventricular tachycardia. Circulation 107:307–312PubMedCrossRef

94.

Wacker-Gussmann A, Strasburger JF, Cuneo BF, Wakai RT (2014) Diagnosis and treatment of fetal arrhythmia. Am J Perinatol 31:617–628PubMedPubMedCentralCrossRef

95.

Willruth A, Steinhard J, Enzensberger C et al (2016) Fetal colour tissue Doppler imaging (cTDI): biventricular reference ranges for the time segments of the cardiac cycle in second and third trimesters of gestation. Arch Gynecol Obstet 294:917–924PubMedCrossRef

96.

Yuan SM, Xu ZY (2020) Fetal arrhythmias: prenatal evaluation and intrauterine therapeutics. Ital J Pediatr 46:21PubMedPubMedCentralCrossRef

Titel: Fetale Arrhythmien – ein Update
verfasst von: Prof. Dr. Ulrich Gembruch
Publikationsdatum: 22.12.2021
Verlag: Springer Medizin
Schlagwörter: Tachykarde Herzrhythmusstörungen
Supraventrikuläre Tachykardien
Ventrikuläre Tachykardien
Echokardiografie
Lupus erythematodes
AV-Block
AV-Reentry-Tachykardie
Hydrops fetalis
Echokardiografie
Hydroxychloroquin
Erschienen in: Die Gynäkologie / Ausgabe 1/2022
Print ISSN: 2731-7102
Elektronische ISSN: 2731-7110
DOI: https://doi.org/10.1007/s00129-021-04887-1

Neu im Fachgebiet Gynäkologie und Geburtshilfe

17.04.2024 | Postoperative nausea and vomiting | Nachrichten

Update Gynäkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert – ganz bequem per eMail.

Newsletter bestellen

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Fetale Arrhythmien – ein Update

Zusammenfassung

Neu im Fachgebiet Gynäkologie und Geburtshilfe

Hochrisiko-Eingriffe für postoperative Übelkeit

Adjuvante Brustkrebstherapie: Doppelt hält besser

Manche Gestagene können das Risiko für Meningeome erhöhen

Stillende Frauen haben geringeres kardiovaskuläres Risiko

Update Gynäkologie

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Zusammenfassung

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 1/2022

Vorteile der 3-D/4-D-Echokardiographie – Neuerungen und Ausblick

Künstliche Intelligenz in der pränatalen kardialen Diagnostik

Ein Relikt aus der Embryonalentwicklung?

CME: Genitalchirurgische Maßnahmen zur Feminisierung bei Geschlechtsdysphorie

Wer entscheidet beim Schwangerschaftsabbruch Minderjähriger?

Medizinrecht

Neu im Fachgebiet Gynäkologie und Geburtshilfe

Hochrisiko-Eingriffe für postoperative Übelkeit

Adjuvante Brustkrebstherapie: Doppelt hält besser

Manche Gestagene können das Risiko für Meningeome erhöhen

Stillende Frauen haben geringeres kardiovaskuläres Risiko

Update Gynäkologie