Monitoring of Women with Anti-Ro/SSA and Anti-La/SSB Antibodies in Germany—Status Quo and Intensified Monitoring Concepts
<b>Background:</b> The fetuses of pregnant women affected by anti-Ro/anti-La antibodies are at risk of developing complete atrioventricular heart block (CAVB) and other potentially life-threatening cardiac affections. CAVB can develop in less than 24 h. Treatment with anti-inflammatory d...
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| Format: | Article |
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MDPI AG
2024-02-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/13/4/1142 |
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| author | Ivonne Alexandra Bedei David Kniess Corinna Keil Aline Wolter Johanna Schenk Ulrich J. Sachs Roland Axt-Fliedner |
| author_facet | Ivonne Alexandra Bedei David Kniess Corinna Keil Aline Wolter Johanna Schenk Ulrich J. Sachs Roland Axt-Fliedner |
| author_sort | Ivonne Alexandra Bedei |
| collection | DOAJ |
| description | <b>Background:</b> The fetuses of pregnant women affected by anti-Ro/anti-La antibodies are at risk of developing complete atrioventricular heart block (CAVB) and other potentially life-threatening cardiac affections. CAVB can develop in less than 24 h. Treatment with anti-inflammatory drugs and immunoglobulins (IVIG) can restore the normal rhythm if applied in the transition period. Routine weekly echocardiography, as often recommended, will rarely detect emergent AVB. The surveillance of these pregnancies is controversial. Home-monitoring using a hand-held Doppler is a promising new approach. <b>Methods:</b> To obtain an overview of the current practice in Germany, we developed a web-based survey sent by the DEGUM (German Society of Ultrasound in Medicine) to ultrasound specialists. With the intention to evaluate practicability of home-monitoring, we instructed at-risk pregnant women to use a hand-held Doppler in the vulnerable period between 18 and 26 weeks at our university center. <b>Results:</b> There are trends but no clear consensus on surveillance, prophylaxis, and treatment of anti-Ro/La positive pregnant between specialists in Germany. Currently most experts do not offer home-monitoring but have a positive attitude towards its prospective use. Intensified fetal monitoring using a hand-held Doppler is feasible for pregnant women at risk and does not lead to frequent and unnecessary contact with the center. <b>Conclusion:</b> Evidence-based guidelines are needed to optimize the care of anti-Ro/La-positive pregnant women. Individual risk stratification could help pregnancy care of women at risk and is welcmed by most experts. Hand-held doppler monitoring is accepted by patients and prenatal medicine specialists as an option for intensified monitoring and can be included in an algorithm for surveillance. |
| first_indexed | 2024-03-07T22:27:13Z |
| format | Article |
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| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-07T22:27:13Z |
| publishDate | 2024-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-f68a15b7034549a7978852886e3aeaf02024-02-23T15:22:25ZengMDPI AGJournal of Clinical Medicine2077-03832024-02-01134114210.3390/jcm13041142Monitoring of Women with Anti-Ro/SSA and Anti-La/SSB Antibodies in Germany—Status Quo and Intensified Monitoring ConceptsIvonne Alexandra Bedei0David Kniess1Corinna Keil2Aline Wolter3Johanna Schenk4Ulrich J. Sachs5Roland Axt-Fliedner6Department of Prenatal Diagnosis and Fetal Therapy, Justus-Liebig University Giessen, 35392 Giessen, GermanyDepartment of Prenatal Diagnosis and Fetal Therapy, Philipps-University Marburg, 35041 Marburg, GermanyDepartment of Prenatal Diagnosis and Fetal Therapy, Philipps-University Marburg, 35041 Marburg, GermanyDepartment of Prenatal Diagnosis and Fetal Therapy, Justus-Liebig University Giessen, 35392 Giessen, GermanyDepartment of Prenatal Diagnosis and Fetal Therapy, Justus-Liebig University Giessen, 35392 Giessen, GermanyInstitute for Clinical Immunology and Transfusion Medicine, Justus-Liebig University, 35392 Giessen, GermanyDepartment of Prenatal Diagnosis and Fetal Therapy, Justus-Liebig University Giessen, 35392 Giessen, Germany<b>Background:</b> The fetuses of pregnant women affected by anti-Ro/anti-La antibodies are at risk of developing complete atrioventricular heart block (CAVB) and other potentially life-threatening cardiac affections. CAVB can develop in less than 24 h. Treatment with anti-inflammatory drugs and immunoglobulins (IVIG) can restore the normal rhythm if applied in the transition period. Routine weekly echocardiography, as often recommended, will rarely detect emergent AVB. The surveillance of these pregnancies is controversial. Home-monitoring using a hand-held Doppler is a promising new approach. <b>Methods:</b> To obtain an overview of the current practice in Germany, we developed a web-based survey sent by the DEGUM (German Society of Ultrasound in Medicine) to ultrasound specialists. With the intention to evaluate practicability of home-monitoring, we instructed at-risk pregnant women to use a hand-held Doppler in the vulnerable period between 18 and 26 weeks at our university center. <b>Results:</b> There are trends but no clear consensus on surveillance, prophylaxis, and treatment of anti-Ro/La positive pregnant between specialists in Germany. Currently most experts do not offer home-monitoring but have a positive attitude towards its prospective use. Intensified fetal monitoring using a hand-held Doppler is feasible for pregnant women at risk and does not lead to frequent and unnecessary contact with the center. <b>Conclusion:</b> Evidence-based guidelines are needed to optimize the care of anti-Ro/La-positive pregnant women. Individual risk stratification could help pregnancy care of women at risk and is welcmed by most experts. Hand-held doppler monitoring is accepted by patients and prenatal medicine specialists as an option for intensified monitoring and can be included in an algorithm for surveillance.https://www.mdpi.com/2077-0383/13/4/1142rheumatic disease in pregnancyfetal atrioventricular blockhome monitoringanti-Ro/anti-La antibodieslupus erythematosusSjögren syndrome |
| spellingShingle | Ivonne Alexandra Bedei David Kniess Corinna Keil Aline Wolter Johanna Schenk Ulrich J. Sachs Roland Axt-Fliedner Monitoring of Women with Anti-Ro/SSA and Anti-La/SSB Antibodies in Germany—Status Quo and Intensified Monitoring Concepts Journal of Clinical Medicine rheumatic disease in pregnancy fetal atrioventricular block home monitoring anti-Ro/anti-La antibodies lupus erythematosus Sjögren syndrome |
| title | Monitoring of Women with Anti-Ro/SSA and Anti-La/SSB Antibodies in Germany—Status Quo and Intensified Monitoring Concepts |
| title_full | Monitoring of Women with Anti-Ro/SSA and Anti-La/SSB Antibodies in Germany—Status Quo and Intensified Monitoring Concepts |
| title_fullStr | Monitoring of Women with Anti-Ro/SSA and Anti-La/SSB Antibodies in Germany—Status Quo and Intensified Monitoring Concepts |
| title_full_unstemmed | Monitoring of Women with Anti-Ro/SSA and Anti-La/SSB Antibodies in Germany—Status Quo and Intensified Monitoring Concepts |
| title_short | Monitoring of Women with Anti-Ro/SSA and Anti-La/SSB Antibodies in Germany—Status Quo and Intensified Monitoring Concepts |
| title_sort | monitoring of women with anti ro ssa and anti la ssb antibodies in germany status quo and intensified monitoring concepts |
| topic | rheumatic disease in pregnancy fetal atrioventricular block home monitoring anti-Ro/anti-La antibodies lupus erythematosus Sjögren syndrome |
| url | https://www.mdpi.com/2077-0383/13/4/1142 |
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