Q. What does intact septal defect mean?
Hi doctor,
My wife is 23 years old. She is 22 weeks pregnant. She has a previous history of complete CHB - congenital heart block diagnosed at the 20th week of her first pregnancy and it was terminated. In her present pregnancy, two weeks back that is around the 20th week cardiologist did fetal echo and told everything is fine. But, he said that there are some holes and they will close automatically after birth. I need some valuable information about my baby. What are they and how it will close automatically? What does septal defect intact mean? Is there any suggestible medication? Both cardiologist and obstetrician said that babies will have holes while in the uterus and they will close after birth. Is that true? Please advise and tell me the actual fact. I heard that some holes will not close and need surgery.
Since her third month, my wife has been taking Wysolone 5 mg one tablet in the morning and a half tablet in the evening. Also, HCQ 200 once daily at night for precaution of CHB. Recently, Wysolone 5 mg dosage was changed to daily one tablet. She is also on Sandocal daily two tablets, Livogen, Folvite, Ecosprin 75 daily one. She had Progesterone SR 200 mg daily two from her second month to 21 weeks and stopped. I am providing fetal echo report for reference.
Thank you.
Hi,
Welcome to icliniq.com.
Thank you for sharing your wife's history, diagnosis, and pertinent reports (attachment removed to protect patient identity).
- First of all, your baby has a normal heart and has no heart problems.
- All fetuses when inside the womb of the mother, they are required to have a small hole in between the top two chambers of the heart. This is called foramen ovale. I call this as a normal hole all fetuses have and after the fetus gets delivered, this normal hole spontaneously closes.
- In some babies, it might take just a few hours, and in some babies a few days for this to close. So, your baby has a similar normal hole in between the top two chambers of the heart and is a small one. It will close by itself after the baby gets delivered.
- The ventricular septum is the wall that separates the two bottom pumping chambers of the heart. There is no hole in this wall in a normal heart. In your baby's fetal echo, they mentioned that this wall is intact, meaning that they did not see any problem causing a hole. This is good news.
- Because your wife has an inflammatory, connective tissue disease called SLE (systemic lupus erythematosus), there will be antibodies in her that can pass to the baby and react with the baby's heart especially the electrical cells of the heart. Hence, the previous baby had a congenital heart block.
- There are chances for this to reoccur in future pregnancies. Hence, some medications suppress this inflammation. Your wife is appropriately being placed on such anti-inflammatory medicines namely Wysolone (Prednisolone) and HCQ 200 (Hydroxychloroquine).
- The good news for now is that there is no problem with the baby's heart rate and there is no evidence of heart block in the fetal echo. But, she needs to be constantly monitored for the baby's heart rate as the problem can happen later also.
- Your baby has just a normal hole and will close spontaneously after delivery. There is no problem with holes in the heart as per the echo report and hence, no surgical intervention is needed.
Thank you doctor,
Really, I am very happy to see your detailed reply. Should she continue Wysolone 5 mg daily for the full term of pregnancy? The cardiologist given a picture of the heart and rounded where the holes are. I have uploaded the image here. Please have a look.
Hi,
Welcome back to icliniq.com.
Thank you for your positive feedback and I greatly appreciate it.
- There is no proven evidence of routinely giving prenatal Prednisone to prevent heart block in future pregnancies.
- According to the echo report, the fetal heart rate is normal. But, I do not see a mechanical PR interval measurement in this report.
- If this is also normal, then there is no evidence of even first degree heart block, which is an early evidence of damage to the electrical cells in fetal heart due to the antibodies.
- Assuming that there is no first degree heart block in the current baby, routinely giving Wysolone to mom is of no benefit. Also, this medication is with some side effects to both mom and baby.
- Please ask the cardiologist if there is a first degree heart block in the fetus, if there is none, then Wyslone is not recommended. But ,if there is evidence of first degree heart block in the fetus, then maybe there is an indication for steroid medicine.
- Again the picture shows (attachment removed to protect patient identity) the small hole in between top two chambers of heart, which is a normal hole in the fetus. There is nothing to worry about the hole here.
For further information consult a paediatrician online --> https://www.icliniq.com/ask-a-doctor-online/paediatrician
I hope you are fine with healthy always for us and today we went to Fernandez Hopsital for PR Interval Check Doctor told like everything is fine and no indication of heart damage till now but suggested to continue wysolone and hcqs and come back after 2 weeks for pr interval check. So i am providing the report for examination also waiting for ur valuble opinion and guidance.
Thank you
T Hari
9032584745
Thank you for contacting icliniq again.
Great that the mechanical PR interval is normal. Fetal heart rate is also normal.
1. The most vulnerable period for heart block to happen is 18-24 weeks. She is probably already 23 weeks now right and its good that there is no evidence for heart block.
2. Wyslone is started only to prevent heart block in baby by your doctors right? Is this correct? The reason i ask this is because prednisone can be used for any maternal indication but not for the baby.
2.As i mentioned in my earlier answer, prednisone is not recommended for preventing heart block in future pregnancies. It does not cross placenta and does not reach the fetus at all. But it comes with side effects to both baby and mother. Also long term studies have shown neurodevelopmental abnormalities in the childhood for fetuses exposed to steroids for long time.
3. I recommend constant monitoring for fetal heart rate, PR interval atleast every 2 weeks. Recommend stopping prednisone. HCQ may be continued because it is for maternal indication.
Hope this helps. Thanks for contacting me again.
actually i asked my consultant obstetrician and Rheumatologist to stop predinsolone but they are opposing they didnt understand my concern about that so am feeling sadly Rheumatologist saying like its a very small dose nothing to worry. You right madam my wife has SSA, SSB, RO-52 positive detected while first pregnenacy CHB am providing that report here. Finally how can we approach plz guide me
Thank you very much
I will contact you again with further developments
Hari
I am quoting below a journal from rheumatology. Refer to first paragraph in page 2 regarding nonflourinated steroid use. It clearly explains why prednisone is not helpful in prevention of heart block in fetus as it does not cross placenta to reach the fetus.
Rheumatology (Oxford). 2008 Jun;47 Suppl 3:iii35-7. doi: 10.1093/rheumatology/ken153.
Prevention of congenital heart block in children of SSA-positive mothers.
With the above evidence as well as with my clinical experience, I recommend stopping prednisone. however, HCQ has shown to have some benefit and hence it can be continued.
Hope this helps.
Finally my wife delivered a baby boy (1840 grams birth weight) on 30th January 2017 Intial ECG reportes has high QTC Levels later 16th February taken another ECG showed normal and we consulted paediatric cardialogist on 20th february. The Doctor told everything is normal dont worry and go for ecg after 3 months If that one also shows normal no need to relook actually doctor mentioned in prescription is "baby in synus rhythm, reassured". I feel you are the expert and best doctor for us to take advise to clear all worrys. So sincerely i request you please verify all reports and guide me. Baby present weight 2500 grams.
Thank you
T Hari
I have uploaded few reportes
1. ECG (1st February)
2. ECG (16th February)
3. Doctor prescription
Congratulations! That's great to hear about the health of your baby. I looked at the ECGs and its not unusual to have a some what long QTc in new born period. Anyways, better to repeat it in 3 months of age as your doctor had suggested to make sure its not a true long QT syndrome.
Once again congratulations and great to hear back from you.
May I know the Internal meaning of "baby in synus rhythm" and will you suggest any care for my baby
Sinus rhythm is normal rhythm or normal pattern of heart beat. So, your baby's heart is beating normally. Repeat ECG in 3 months to follow up on QTc interval. No other follow up is required if theECG is normal at 3 months. Everything is reassuring so far. Hopefully that clears your concerns.
Thanks
Was this answer helpful?
|Same symptoms doesn’t mean you have the same problem. Consult a doctor now!
Related Questions:
Counseling for Newly Weds
.. sexual problems that the newly weds usually face are discussed .. ... Read full
My mother is taking six pills of 20 mg Prednisone every other day. Is it too much?.. not used in infection. In fact, if a person has an infection, then steroids will flare it and result in septic shock, as they decrease immunity. If a doctor has prescribed it, that means the kidney infection is less likely. Read full
Where should I insert my penis during intercourse?.. your query and understand your concerns. The vaginal opening is located at the junction of the upper two thirds and the lower one third between the two soft skins and there you need to insert the penis while having intercourse. Read full
Also Read Answers From:
Comprehensive Medical Second Opinion.Submit your Case
iCliniq's FREE Newsletters
Expert-backed health and wellness information, delivered to your email.
Thank you for subscribing to our Newsletters!
Also Read
PCOS and Liver Problems
The hormonal imbalances in polycystic ovary syndrome could cause liver diseases. Read the article to know the relationship between these medical conditions. Read more»
Inferior Alveolar Nerve Lateralization Technique
The inferior alveolar nerve lateralization technique is a surgical lateralization technique to reposition the nerve. Read the article to know more about this. Read more»
COVID-19 and Ebola: Similarities and Differences
This article gives a comparison and broader overview of the outbreak of the two deadliest diseases that showed a greater incidence over the last two decades. Read more»
Ask your health query to a doctor online?
Ask a Paediatrician Now* guaranteed answer within 4 hours.