ABC | Volume 112, Nº5, May 2019

Guideline Brazilian Fetal Cardiology Guidelines – 2019 Arq Bras Cardiol. 2019; 112(5):600-648 Figure 6.2 – Recommendations for fetal ductal constriction treatment during the third gestational trimester. In cases in which there is no reversal of the ductal constriction and its consequences after initiation of treatment, preterm delivery may be considered, since fetal pulmonary maturity has been established. Class of recommendation: IIb; Level of evidence: C. 30mg RECOMMENDATIONS FOR FETAL DUCTAL CONSTRICTION TREATMENT DURING THE THIRD GESTATIONAL TRIMESTER Non-steroidal anti- inflammatory drugs Restricted substances Class of recommendation I; level of evidence A Other medications with possible anti- inflammatory effects - corticoids - scopolamine - aspirin - fluoxetine - isoxsuprine - naphazoline - sertraline - dipyrone - paracetamol - paroxitine Substances that use interruption may be considered Class of recommendation IIa; level of evidence C DO NOT CONSUME - Oranges - Orange juice - Green tea - Black tea - Boldo tea - Coffee - Yerba mate - Dark chocolate - Cocoa powder - Olive oil - Purple/red/pink graps - Grape juice Consume as indicated in Annex 1: - Raw beet - Lettuce - Purple/red plums, unpeeled - Blackberries/mulberries - Red apples/unpeeled - Papaya - Strawberries - Green herbs Foods with more than 30 mg of polyphenol/100 g improved the understanding of fetal cardiac rhythm abnormalities. Since fetal arrhythmias may severely compromise the gestation outcome, it is very important to diagnose, recognize the mechanisms, hemodynamic consequences, and the fetal cardiac morphology for perinatal therapy planning. Fetal cardiac rhythm abnormalities affect approximately 0.5–2% of pregnancies, and are responsible for 10–20% of referrals for in utero cardiac examination. The ectopic beats are the most prevalent rhythm irregularities seen during fetal heart. They are usually benign however, may potentially trigger a sustained supraventricular tachycardia (SVT) especially when they are blocked. Some fetal cardiac arrhythmias, however, are considered emergencies in Fetal Cardiology, requiring early diagnosis and treatment and have determinant impact on perinatal morbidity and mortality. Complete heart block (CAVB), atrial flutter (AF), and SVT may have severe consequences for the fetus clinical status. 128 625