Review Paper. Transplacental Digoxin Treatment In Prenatal Cardiac Problems In Singleton Pregnancies - Meta Analysis (Based On Literature: 1992–2015)

Open access

Abstract

Based on fourteen case reports from various centres from 1992-2015 and three original studies in 2006-2011, 122 fetuses were subjected to analysis. In these reports, transplacental digoxin treatment was administered to different cardiac anomalies such as SVT , Ebstein’s anomaly, critical AS , absent pulmonary valve syndrome, complete heart block, in foetuses with aneurysm/diverticulum of LV, in tricuspid atresia or dysplasia, rhabdomyoma, pulmonary atresia, HLHS with fibroelastosis, in TTTS and in extracardiac anomalies such as atriovenous malformation or sacrococcygeal teratoma. There was no statistical difference to suggest (Chi-square test) that digoxin was more efficient to control fetal arrhythmias than fetal congestive heart failure in nonarrhythmic patients.

Conclusions: Foetal cardiac insufficiency may appear due to different reasons (in normal heart anatomy or in heart defects, in normal sinus rhythm or due to foetal arrhythmias: tachycardias or severe bradycardia) and may be a cause of intrauterine demise. So far, we do not have strong evidence that digoxin treatment may prevent foetal death or prematurity. More research is needed to ascertain if the prolonging of pregnancy resulted from digoxin treatment or if improvement in foetal circulatory insufficiency was influenced by spontaneous regression of foetal cardiac symptoms.

If the inline PDF is not rendering correctly, you can download the PDF file here.

  • 1. Herman Z. Medicine of the positive inotropic activity. Pharmacology. Basics of pharmacology. PZWL . State Institutions of Medical Publishers]. 1998 542-551.

  • 2. Giec L Herman ZS. Pharmacotherapy of Circulatory System Diseases. PZWL State Institutions of Medical Publishers 1987

  • 3. Ishikawa S Yin J Maeda H Satoh S Takeuchi A Yasui H Koyanagi T Nakano H. Successful Intrauterine Digoxin Therapy for Fetal Complete. Atrioventricular Block with Endocardial Cushion Defect. Fukuoka Igaku Zasshi. 1992 83 (7) 315-318

  • 4. Koike T Minakami H Shiraishi H Ogawa S Matsubara S Honma Y SatoI I. Digitalization of the Mother in Treating Hydrops Fetalis in Monochorionic. Twin with Ebstein’s Anomaly. J Perinat Med. 1997 25 (3) 295-297

  • 5. Hsieh YY Lee CC Chang CC Tsai HD Yeh LS Tsai CH. Successful Prenatal Digoxin Therapy for Ebstein’s Anomaly with Hydrops Fetalis. J. Reprod Med. 1998 43(8) 710-712

  • 6. Brackley KJ Ismail KM Wright JG Kilby MD. The Resolution of Fetal Hydrops Using Combined Maternal Digoxin and Dexamethasone Therapy in a Case of Isolated Complete Heart Block at 30 Weeks Gestation. Fetal Diagn Ther. 2000 15(6) 355-358

  • 7. Respondek-Liberska M Jarosik K Janiak K Sysa A Kowalska-Koprek UWilczyński J Stańczyk J. Outcome Offetuses with Tachyarrhythmias >200/ min - Bicenter Łódź Study. Polish Journal of Cardiology 2006 8(1) 35-39

  • 8. Patel D Cuneo B Viesca R Rassanan J Leshko J Huhta J. Digoxin for the Treatment of Fetal Congestive Heart Failure with Sinus Rhythm Assessed by Cardiovascular Profile Score. Journal of Maternal-Fetal and Neonatal Medicine 2008 21 (7): 477-82

  • 9. Radzymińska-Chruściel B Respondek-Liberska M. Monitoring of Fetus Echocardiography with Critical Valvular Aortic Stenosis. Ultrasonography 2008 8(1) 43

  • 10. Pradhan M Dalal A Kapoor A Kumar S Manisha R.: Fetal Left Ventricular Diverticulum Presenting as Dysrhythmia: Diagnosis and Management. Fetal Diagn Ther. 2008 23(1)10-14

  • 11. Śliwa J Respondek-Liberska M Maroszyńska I Krasomski G. Ebstein’s Malformation in the Fetus with Cardiomegaly. To Treat or to Observe? Ginekol Pol. 2010 81(2)135-139

  • 12. Sokol V Juras J Malćić Blajić J Ivaniśević M. Digoxin and Amiodaron in fetal sustained supraventriclar tachycardia and nonimmune hydrops. Gynaecol Perinatal. 2011 20 (1)44-47

  • 13. Jaeggi E.T Carvalho J.S De Groot E Api O Clur S.B Rammeloo L McCrindle B.W Ryan G Manlhiot C Blom N.A. Comparison of Transplacental Treatment of Fetal Supraventricular Tachyarrhythmias With Digoxin Flecainide and Sotalol. Circulation. 2011 124 1747-1754

  • 14. Hirose A Maeno Y Suda K Fusazaki N Kado H Matsuishi T.Serial Hemodynamic Assessment Using Doppler Echocardiography in a Fetus with Left Ventricular Aneurysm Presented as Fetal Hydrops. J Perinatology 201333(6) 486-489

  • 15. Dayton JD Carroll SJ Horowitz JM Flynn PA Chasen ST. Maternal and fetal digoxin levels in the treatment of fetal supraventricular tachycardia. Ultrasound Obstet Gynecol. 2014 44146

  • 16. DeJong S Salmanian B Shamshirsaz AA Ruano R. Perinatal Management of Fetal Supraventricular Tachycardia Complicated by Maternal Pertussis.. BMJ. 2015

  • 17. Wilkins W Kendall M.J Wade O. Wiliam Withering and Digitalis 1785-1985. British Med Journal. 1985 290 7-8

  • 18. Ahmed A Aronow W Fleg J.: Predictors of Mortality and Hospitalization in Women with Heart Failure in the Digitalis Investigation Groups Trial. Am J Ther. 2006 13 (4) 325-331

  • 19. Kerenyi TD Gleicher N Meller J Brown E Steinfeld L Chitkara U Raucher H. Transplancental cardioversion of intrauterine supraventricular tachycardia with digitalis. Lancet 1980 2393-394

  • 20. Kleinman CS Donnerstein RL DeVore GR Jaffe CC Lynch DC Berkowitz RL Talner NS Hobbins JC. Fetal Echocardiography for Evaluation of in Utero Congestive Heart Failure. N Engl J Med. 1982 306(10) 568-575

  • 21. Jaeggi E Fouron J Fournier A van Doesburg N Drblik SP Proulx F. Ventriculo-atrial Time Interval Measured on M Mode Echocardiography; a Determining Element in Diagnosis Treatment and Prognosis of Fetal Supraventricular Tachycardia. Heart 1998 79582-587

  • 22. Fouron J Proulx F Miró J Gosselin J. Doppler and M-mode Ultrasonography to Time Fetal Atrial and Ventricular Contractions. Obstet Gynecol. 2000 96732-736

  • 23. DeLia J Emery MG Shoafor S Jennison T. Twin transfusion syndrome: Successful in utero treatment with digoxin. Int J Gynaecol Obstet. 198523197-201

  • 24. Arabin B Laurim RN van EyckJ Nicolaides KH. Treatment of twin-twin transfusion syndrome by laser and digoxin. Fetal Diagn Ther. 1998 13 141-146

  • 25. Simpson J. Fetal arrhythmias. In: Textbook of fetal cardiology. Ed. Allan L Hornberger L Sharland G. Londyn: Greenwich Medical Media. 2000 423-437

  • 26. Azancot-Benisty A Jacqz-Aigrain E Guirgis NM Decrepy A Oury JF Blot P. Clinical and Pharmacologic Study of Fetal Supraventricular Tachyarrhythmias. J Pediatr. 1992 121 608-613

  • 27. Respondek-Liberska M. Echocardiography and Fetus Cardiology. Makmed Gdańsk 1998

  • 28. Fouron J. Fetal Arrhythmias: the Saint-Justine Hospital Experience. Prenat Diagn. 2004 241068-1080

  • 29. Simpson J Sharland G. Fetal Tachycardias: Management and Outcome of 127 Consecutive Cases. Heart 1998 79: 576-581

  • 30. Parilla B Strasburger J Sokol M. Fetal Supraventricular Tachycardia Complicated by Hydrops Fetalis: a Role for Direct Fetal Intramuscular Therapy. Am J Perinatology. 1996 13 483-486

  • 31. Kleinman C Copel J. Direct Fetal Therapy for Cardiac Arrhythmias: Who What When Where Why and How? Ultrasound Obstet Gynecol. 19911 158-160

  • 32. Dangel J Roszkowski T Bieganowska K Kubicka K Ganowicz J. Adenosine Triphosphate for Cardioversion of Supraventricular Tachycardia in Two Hydropic Fetuses. Fetal Diag Therapy. 2000 15 326-330Current Status of Knowledge Concerning the Prenatal Therapy. Opinion

  • 33. of the Group of Experts of PTG. In: The Recommendations of Polish Gynaecological Association 2003- 2007. Gynaecology after Diploma 2008 108-141

  • 34. Hamela-Olkowska A Szymkiewicz-Dangel J. Tachyarrhythmia by Fetus - Current Knowledge. Ginekol Pol. 2010 81 844-850

  • 35. Respondek-:iberska M Szeligowski M Wilczyński J Oszukowski P Szaflik K Krasomski G Pertyński T. Digoxin Therapy of Fetus. Arch Perinat Med 1996131-36

  • 36. ShartonML Irani WN Hall SA Marcoux LG Page RL Grayburn PA Eichhorn EJ. Does digoxin provide additional hemodynamic and autonomic benefit at higher doses in patients with mild to moderate heart failure and normal sinus rhythm? J Am Coll Cardiol 1997 291206-1213

  • 37. Cuneo BF Lee M Roberson D Niksch A Ovadia M Parilla BV Benson DW.: A management strategy for fetal immune-mediated atrioventricular block. J Matern Fetal Neonatal Med. 2010 23 (12) 1400-1405

  • 38. Wiggins JW Jr Bowes W Clewell W Manco-Johnson M Manchester DJohnson R Appareti K Wolfe RR. Echocardiographic diagnosis and intravenous digoxin management of fetal tachyarrhythmias and congestive heart failure. Am J Dis Child. 1986 140 (3) 202-204

  • 39. Mielke G Steil E Gonser M. Prenatal diagnosis of idiopathic stenosis of the ductus arteriosus associated with fetal atrial flutter. Fetal Diagn Ther. 1997 12 (1) 46-49

  • 40. Zhou KY Hua YM Zhu Q. Transplacental digoxin therapy for fetal atrial flutter with hydrops fetalis.World J Pediatr. 2012 8 (3) 275-277

  • 41. Strizek B Berg C Gottschalk I Herberg U Geipel A Gembruch U. High-dose flecainide is the most effective treatment of fetal supraventricular tachycardia. Heart Rhythm. 2016 13(6) 1283-1289

  • 42. Itoh S Tanaka C Nakamura YYoshida K Mitsuhashi N Takeuchi H Kuwabara Y. Prenatal management of fetal cardiac tumors. Two case reports. Fetal Diagn Ther.1996 11(5) 361-365

  • 43. Hoeschen RJ Proveda V. Serum digoxin by radioimmunoassay. Can Med Assoc J. 1971105(2) 170-173

  • 44. Bodem G. Radioimmunological estimation of cardiac glycoside concentration in the plasma. Prakt Anaesth. 197611(2)97-100

  • 45. Fürst B1 Luckner M. EDLS (endogenous digitalis-like substance(s) detection chemistry and physiologic function. Pharmazie. 198843(11)744-748

  • 46. Kerkez SA1 Poston L Wolfe CD Quartero HW Carabelli P Petruckevitch A Hilton PJ. A longitudinal study of maternal digoxin-like immunoreactive substances in normotensive pregnancy and pregnancy-induced hypertension. J Obstet Gynecol. 1990162(3)783-787

  • 47. Di Grande A1 Boura AL Read MA Malatino LS Walters WA. Release of a substance from the human placenta having digoxin-like immunoreactivity. Clin Exp Pharmacol Physiol. 1993 20(9) 603-607

  • 48. Seccombe DW1 Pudek MR Humphries KH Matthewson B Taylor GP Jacobson BE Whitfield MP. A study into the nature and organ source of digoxin-like immunoreactive substance(s) in the perinatal period. Biol Neonate. 1989.56(3)136-146

  • 49. Schmitt K1 Tulzer G Häckel F Sommer R Tulzer W. Massive digitoxin intoxication treated with digoxin-specific antibodies in a child. Pediatr Cardiol.1994 15(1) 48-49

  • 50. Husby P1 Farstad M Brock-Utne JG Koller ME Segadal L Lund T OhmOJ. Immediate control of life-threatening digoxin intoxication in a child by use of digoxin-specific antibody fragments (Fab). Paediatr Anaesth. 200313(6) 541-549

  • 51. Eyal D1 Molczan KA Carroll LS. Digoxin toxicity: pediatric survival after asystolic arrest. Clin Toxicol.. 2005 43(1) 51-54

  • 52. Eyal D1 Molczan KA Carroll LS. Digoxin toxicity: pediatric survival after asystolic arrest. Clin Toxicol.. 2005 43(1) 51-54

Search
Journal information
Metrics
All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 589 415 21
PDF Downloads 344 275 19