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1
Department of Obstetrics and Gynaecology, Amsterdam UMC location, University of Amsterdam, Amsterdam, The Netherlands.
2
Amsterdam Reproduction and Development, Amsterdam, The Netherlands.
3
Medical Library, Amsterdam UMC location, University of Amsterdam, Amsterdam, The Netherlands.
4
Centre for Reproductive Medicine, Amsterdam UMC location, University of Amsterdam, Amsterdam, The Netherlands.
5
Department of Pediatric Cardiology, Amsterdam UMC location, University of Amsterdam, Amsterdam, The Netherlands.
1
Department of Obstetrics and Gynaecology, Amsterdam UMC location, University of Amsterdam, Amsterdam, The Netherlands.
2
Amsterdam Reproduction and Development, Amsterdam, The Netherlands.
3
Medical Library, Amsterdam UMC location, University of Amsterdam, Amsterdam, The Netherlands.
4
Centre for Reproductive Medicine, Amsterdam UMC location, University of Amsterdam, Amsterdam, The Netherlands.
5
Department of Pediatric Cardiology, Amsterdam UMC location, University of Amsterdam, Amsterdam, The Netherlands.
Fetal heart-rate irregularities occur in 1-2% of pregnancies and are usually caused by premature atrial contractions (PAC). Although PAC are considered benign, they may be associated with cardiac defects and tachyarrhythmia. We aimed to determine the incidence of congenital heart defects (CHDs) and complications in fetuses with PAC.
This was a systematic review and meta-analysis conducted in accordance with the PRISMA statement for reporting items for systematic reviews and meta-analyses. MEDLINE and EMBASE were searched from 1990 to June 2021 to identify studies on fetuses with PAC. The primary outcome was CHD; secondary outcomes were complications using the endpoints supraventricular tachyarrhythmia (SVT), cardiac failure and intrauterine fetal demise. Meta-analysis of proportions was performed, subdivided into high-risk and low-risk populations based on reason for referral. Pooled incidences with 95% CIs were calculated.
Of 2443 unique articles identified, 19 cohort studies including 2260 fetuses were included. The pooled incidence of CHD in fetuses with PAC was 2.8% (95% CI, 1.5-4.1%), when 0.6% is the incidence expected in the general population. The pooled incidence of CHD was 7.2% (95% CI, 3.5-10.9%) in the high-risk population and 0.9% (95% CI, 0.0-2.0%) in the low-risk population. SVT occurred in 1.4% (95% CI, 0.6-3.4%) of fetuses diagnosed with PAC. Cardiac failure was described in 16 fetuses (1.4% (95% CI, 0.5-3.5%)), of which eight were CHD-related. Intrauterine fetal demise occurred in four fetuses (0.9% (95% CI, 0.5-1.7%)) and was related to CHD in two cases.
Our findings suggest that the risk of CHD in fetuses with PAC is 4-5 times higher than that in the general population. CHD was present more frequently in the high-risk population. Consequently, an advanced ultrasound examination to diagnose PAC correctly and exclude CHD is recommended. Complications of PAC are rare but can result in fetal demise, thus weekly fetal heart-rate monitoring remains advisable to enable early detection of SVT and to prevent cardiac failure. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Objetivo
Las irregularidades de la frecuencia cardíaca del feto se producen en el 1‐2% de los embarazos y suelen estar causadas por contracciones auriculares prematuras (CAP). Aunque las CAP se consideran benignas, pueden asociarse a defectos cardíacos y taquiarritmias. El objetivo fue determinar la frecuencia de cardiopatías congénitas (CC) y las complicaciones en fetos con CAP.
Métodos
Se realizó una revisión sistemática y un metaanálisis de acuerdo con la declaración PRISMA para la presentación de informes sobre revisiones sistemáticas y metaanálisis. Se realizaron búsquedas en MEDLINE y EMBASE desde 1990 hasta junio de 2021 para identificar estudios sobre fetos con CAP. El resultado primario fue la CC y los resultados secundarios fueron las complicaciones mediante taquiarritmia supraventricular (TSV), insuficiencia cardíaca y muerte fetal intrauterina. Se realizó un metaanálisis de proporciones, subdividido en poblaciones de alto y bajo riesgo en función del motivo de remisión a especialista. Se calcularon las incidencias combinadas con un IC del 95%.
Resultados
De los 2443 artículos únicos identificados, se incluyeron 19 estudios de cohortes que incluían 2260 fetos. La incidencia conjunta de CC en fetos con CAP fue del 2,8% (IC 95%, 1,5–4,1%), respecto al 0,6% de incidencia esperada en la población general. La incidencia conjunta de CC fue del 7,2% (IC 95%: 3,5–10,9%) en la población de alto riesgo y del 0,9% (IC 95%: 0,0–2,0%) en la población de bajo riesgo. La TSV se produjo en el 1,4% (IC 95%, 0,6–3,4%) de los fetos diagnosticados con CAP. Se describieron insuficiencias cardíacas en 16 fetos (1,4% [IC 95%, 0,5–3,5%]), de los cuales ocho estaban relacionados con CC. La muerte fetal intrauterina se produjo en cuatro fetos (0,9% [IC 95%, 0,5–1,7%]) y estuvo relacionada con CC en dos casos.
Conclusiones
Los hallazgos sugieren que el riesgo de CC en fetos con CAP es entre 4 y 5 veces superior al de la población general. La CC fue más frecuente en la población de alto riesgo. Por consiguiente, se recomienda un examen ecográfico avanzado para diagnosticar correctamente las CAP y excluir las CC. Las complicaciones de las CAP son raras pero pueden dar lugar a la muerte fetal, por lo que sigue siendo aconsejable el seguimiento semanal de la frecuencia cardíaca del feto para permitir la detección precoz de la TSV y prevenir el fallo cardíaco.
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