PMC8255611_01
The findings of fetal atrioventricular interval monitored by fetal echocardiography. (A,D) Show the fetal atrioventricular (AV) intervals upon diagnosis (170/160 ms) at 25 gestational weeks (GWs). Panels B/E show the findings (145/136 ms) of medium term after treatment with oral dexamethasone at 30 GWs. (C,F) Show the final echocardiography prior to delivery (130/127 ms) at 35 GWs. (A-C) Belong to the fetus of case 1-twin A, and (D-F) belong to the fetus of case 1-twin B. ms, millisecond.
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F1
Oral dexamethasone (4.5 mg daily as initial dose) and HCQ (200 mg bid) as well as weekly follow-up surveillance with fetal ultrasound (Figure 1 as the example of the twins) were performed until to the end of the pregnancy in our center.
Dexamethasone dose adjustments and fetal atrioventricular intervals. The dose of dexamethasone (Dex) was adjusted according to the change in the fetal atrioventricular (AV) intervals at different gestational weeks (GWs) throughout the pregnancy. (A) Represents the fetuses of case 1; (B) represents the fetus of case 2; (C) shows the fetuses of case 3; (D) shows the fetus of case 4. mg, milligram.
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F2
Dexamethasone dose was adjusted with the changes of fetal AV intervals and fetal development of biparietal diameters (BPD) and femur lengths (FL), as shown in Figure 2.
Adverse effects of dexamethasone on fetal growth and Catch-up growths during the first year of life. The fetal biparietal diameters (BPD) and femur lengths (FL) were ~50th percentile after the initiation of dexamethasone, as shown in five fetuses (A,B). The changes in head circumference (HC) (C) and abdominal circumference (AC) (D) of the fetus in case 2 were ~5th percentile. The heights (E), weights (F), and head circumference (HC) (G) of the three infants in case 1 and case 2 during their monthly follow-up visits gradually increased and even exceeded the 3rd percentile via postnatally catch-up growth. GWs, gestational weeks; Kg, kilogram; cm, centimeter.
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F3
We found the BPD and FL of five fetuses were ~50th percentile (Figures 3A,B), while the HC and AC of the fetus in case 2 were ~5th percentile (Figures 3C,D), revealing the growth retardation of these fetuses, especially the fetus in case 2. Measurements of height, body weight, and HC were used to estimate the effectiveness of postnatally catch-up growth, as shown in Figures 3E-G that the height and body weight gradually increased and exceeded 3rd percentile in case 1 and case 2.