Letter Regarding Article by Jaeggi et al, “Transplacental Fetal Treatment Improves the Outcome of Prenatally Diagnosed Complete Atrioventricular Block Without Structural Heart Disease”

Abstract

To the Editor: Jaeggi et al conclude “a standardized approach using dexamethasone and beta-stimulation … improved the outcome of isolated fetal complete heart block (CHB).”1 They used this approach in one 7-year period (90% steroid use; 80% survival) and contrasted it with the preceding 7-year period (19% steroid use; 44% survival). We have grave concerns in accepting that their “standardized approach” was responsible for the improved outcome—other reasons and chance alone cannot be excluded. To put their results in perspective, we reviewed our results for all fetuses with anti-Ro associated congenital CHB observed at our center since 1990 (same time period as Jaeggi et al). Dexamethasone and beta-stimulation were used empirically for fetal compromise, adverse outcome in previous pregnancies, or incomplete heart block. Our results differ from Jaeggi et al …