3 minute read
preventing stillbirths through better fetal heart monitoring
by Connexions
TThe fetal magnetocardiography (fMCG) device looks, in the words of one dad, “like R2-D2 hanging from the ceiling.” But when gently pressed against a pregnant woman’s belly, this groundbreaking tool can do something more amazing than any movie robot: it records the natural magnetic signals that come from the fetal heart rhythm, improving diagnosis and guiding treatment for heart arrhythmias before a baby is even born. The safe, non-invasive procedure could also prevent stillbirths. It’s estimated that roughly 10 percent of unexplained stillbirths may be due to cardiac causes. Between 3 to 10 percent of stillbirths involve inherited conditions that affect the rhythm of the heart. “And those conditions can’t be diagnosed by ultrasound,” notes Janette Strasburger, MD, a fetal electrophysiologist and researcher with the Herma Heart Institute at Children’s Wisconsin. “For 40 years, ultrasound has been the mainstay of all of our diagnoses, and it’s absolutely great for structural defects, but not as good for diagnosing arrhythmias. Until fMCG came along, fetal ultrasound was like a puzzle with many missing pieces.” That’s why Strasburger and Ronald Wakai, PhD, a professor of medical physics at the University of Wisconsin-Madison, have spent years developing fMCG for clinical use. Over the past two decades, they have used fMCG to study more than 900 fetuses, refining how to assess cardiac rhythm patterns in utero. “The premise behind our work is that if we know what a baby has, we usually know how to treat it,” Strasburger says.
The FDA-approved device, known as a Superconducting Quantum Interference Device (SQUID), is available at only a few places in the nation, and Wisconsin is currently the only place using it to assess fetal cardiac conditions. Strasburger is the principal investigator on a four-year, $2.4 million grant from the National Institutes of Health to assess the role of “hidden” fetal arrhythmias in stillbirths, and women with high-risk pregnancies from across the nation travel to Wisconsin to participate in the study. The procedure involves four 10-minute recording sessions, with the entire visit taking two to three hours. Families get immediate results that guide their baby’s treatment plan, and researchers get data that gives them new insights into preventing stillbirths. “We’re finding some fantastic results,” Strasburger says. “The horizon for women at risk of stillbirth is very bright.” While some abnormal heart rhythms are life-threatening, others
Dr. Strasburger reading an fMCG recording. are benign and easily treated, if needed. With the additional information from fMCG, women can avoid early delivery or unnecessary medications. Sometimes supplements to increase a mother’s Vitamin D, magnesium or calcium levels can fix a baby’s abnormal heart rhythm and even reverse heart block, a serious condition that disrupts the heart’s electrical signals.
“Sometimes the most simple things are very effective,” Strasburger says. “We may see instant results, where the baby’s heart rhythm is back to normal the day after treatment is started.” Ideally, fMCG would become the standard of care, used alongside the 20-week ultrasound, Strasburger says.
In the meantime, Strasburger’s study is open to women 18 years and older who are between 20-27 weeks pregnant and who have a prior history of stillbirth or a diagnosis of twin-twin transfusion syndrome or monochorionic twins, a fetal heart defect, a fetal abdominal wall defect or fetal hydrops.
While insurance doesn’t yet cover fMCG, there is no fee to participate in the study. Costs of the test, along with travel expenses for the mother and a companion are covered by grant funds. Participants also receive a small stipend.
To learn more about participating in the study, contact Clinical Research Nurse Coordinator Gretchen Eckstein, RN, BSN, at geckstein@chw. org or 414-266-3539. For more information on Children’s Wisconsin’s fetal heart program, visit childrenswi.org/fetalheart. connexions 25
