(478) Efficacy of In-Utero NSAID versus Expectant Management for Fetal Severe Ebstein Anomaly

To investigate outcomes in pregnancies complicated with fetal severe Ebstein anomaly (EA) in two prenatal management groups: 1) expectant management and 2) non-steroidal anti-inflammatory drugs (NSAIDs).

Study Design:

We searched PubMed, Scopus, and Web of Science systematically from inception until February 2022. Studies reporting on outcomes of severe fetal EA were included. Severe EA was defined as either with the finding of circular shunt, pulmonary atresia, or with grade 3 prognostic score/Celemajer Index. The random-effect model was used to pool the mean differences or odds ratios (OR) and the corresponding 95% confidence intervals. Heterogeneity was assessed using the I² value.

Results:

Total of 14 studies with 598 fetuses in the expectant group and 21 in the NSAIDs were included. Gestational age (GA) at diagnosis and cardiothoracic ratio (CTR) were comparable between the two groups. Type of NSAIDs used included either alone or a combination of indomethacin and ibuprofen until ductal constriction was achieved. Compared to expectant management group, the prenatal ultrasound findings of moderate tricuspid regurgitation , overall pulmonary regurgitation, hydrops, and pericardial effusion were higher among NSAIDs group, suggesting that NSAIDs  group had more severe prenatal presentation that required intervention. Preterm birth (PTB) rate was lower in the expectant management group (25%) than the NSAIDs  (86%). Live birth rate was higher in the NSAIDs (86%) than the expectant management (67%) and similarly was survival at hospital discharge  (43% in expectant management and 89% in NSAIDs).

Conclusion:

Our findings suggest that NSAIDs  may present an effective fetal intervention modalities in cases with severe EA. NSAIDs group encompassed fetuses with more severe prenatal presentation including moderate tricuspid regurgitation, pulmonary regurgitation, hydrops, and pericardial effusion than the expectant group which might have been related to the higher PTB rates. Further research  is necessary to determine  the efficacy of NSAIDs for severe fetal EA.