Abstract
Discussion Forum (0)
Background:
Indomethacin (a prostaglandin synthetase inhibitor) is one of many first line agents for short term tocolysis in preterm labor prior to 32 weeks gestation. It is thought to play an important role in the pathway leading to preterm labor and delivery. Indomethacin has many well-known effects on the developing fetus including constriction or closure of the fetal ductus arteriosus. Studies have emphasized the transient nature of ductal constriction when indomethacin therapy is less than 48 hours with complete resolution typically within 48 hours of cessation.
Case:
A 22 year old, primagravida presented to triage at 29+1 weeks gestational age with contractions and was determined to be in preterm labor. She was admitted and started on an indomethacin course of a 50mg loading dose followed by 25mg every 6 hours for 48 hours. On day two, an ultrasound demonstrated new fetal skin edema. A fetal echocardiogram was concerning for distal ductal arch restriction. About 108 hours after cessation of indomethacin, ultrasound demonstrated resolution of fetal skin edema. One week after indomethacin therapy, another fetal echocardiogram demonstrated no restriction of the ductal arch with normal flow.
Conclusion:
Transient constriction of the fetal ductus arteriosus and the resultant changes on fetal echocardiogram is a well-described phenomenon following maternal exposure to indomethacin. If serial fetal monitoring remains reassuring despite the evidence of new fetal hydrops, it may be reasonable for the team to monitor, rather than proceed to delivery, due to evidence of spontaneous resolution of ductal constriction following indomethacin cessation.
Indomethacin (a prostaglandin synthetase inhibitor) is one of many first line agents for short term tocolysis in preterm labor prior to 32 weeks gestation. It is thought to play an important role in the pathway leading to preterm labor and delivery. Indomethacin has many well-known effects on the developing fetus including constriction or closure of the fetal ductus arteriosus. Studies have emphasized the transient nature of ductal constriction when indomethacin therapy is less than 48 hours with complete resolution typically within 48 hours of cessation.
Case:
A 22 year old, primagravida presented to triage at 29+1 weeks gestational age with contractions and was determined to be in preterm labor. She was admitted and started on an indomethacin course of a 50mg loading dose followed by 25mg every 6 hours for 48 hours. On day two, an ultrasound demonstrated new fetal skin edema. A fetal echocardiogram was concerning for distal ductal arch restriction. About 108 hours after cessation of indomethacin, ultrasound demonstrated resolution of fetal skin edema. One week after indomethacin therapy, another fetal echocardiogram demonstrated no restriction of the ductal arch with normal flow.
Conclusion:
Transient constriction of the fetal ductus arteriosus and the resultant changes on fetal echocardiogram is a well-described phenomenon following maternal exposure to indomethacin. If serial fetal monitoring remains reassuring despite the evidence of new fetal hydrops, it may be reasonable for the team to monitor, rather than proceed to delivery, due to evidence of spontaneous resolution of ductal constriction following indomethacin cessation.
Background:
Indomethacin (a prostaglandin synthetase inhibitor) is one of many first line agents for short term tocolysis in preterm labor prior to 32 weeks gestation. It is thought to play an important role in the pathway leading to preterm labor and delivery. Indomethacin has many well-known effects on the developing fetus including constriction or closure of the fetal ductus arteriosus. Studies have emphasized the transient nature of ductal constriction when indomethacin therapy is less than 48 hours with complete resolution typically within 48 hours of cessation.
Case:
A 22 year old, primagravida presented to triage at 29+1 weeks gestational age with contractions and was determined to be in preterm labor. She was admitted and started on an indomethacin course of a 50mg loading dose followed by 25mg every 6 hours for 48 hours. On day two, an ultrasound demonstrated new fetal skin edema. A fetal echocardiogram was concerning for distal ductal arch restriction. About 108 hours after cessation of indomethacin, ultrasound demonstrated resolution of fetal skin edema. One week after indomethacin therapy, another fetal echocardiogram demonstrated no restriction of the ductal arch with normal flow.
Conclusion:
Transient constriction of the fetal ductus arteriosus and the resultant changes on fetal echocardiogram is a well-described phenomenon following maternal exposure to indomethacin. If serial fetal monitoring remains reassuring despite the evidence of new fetal hydrops, it may be reasonable for the team to monitor, rather than proceed to delivery, due to evidence of spontaneous resolution of ductal constriction following indomethacin cessation.
Indomethacin (a prostaglandin synthetase inhibitor) is one of many first line agents for short term tocolysis in preterm labor prior to 32 weeks gestation. It is thought to play an important role in the pathway leading to preterm labor and delivery. Indomethacin has many well-known effects on the developing fetus including constriction or closure of the fetal ductus arteriosus. Studies have emphasized the transient nature of ductal constriction when indomethacin therapy is less than 48 hours with complete resolution typically within 48 hours of cessation.
Case:
A 22 year old, primagravida presented to triage at 29+1 weeks gestational age with contractions and was determined to be in preterm labor. She was admitted and started on an indomethacin course of a 50mg loading dose followed by 25mg every 6 hours for 48 hours. On day two, an ultrasound demonstrated new fetal skin edema. A fetal echocardiogram was concerning for distal ductal arch restriction. About 108 hours after cessation of indomethacin, ultrasound demonstrated resolution of fetal skin edema. One week after indomethacin therapy, another fetal echocardiogram demonstrated no restriction of the ductal arch with normal flow.
Conclusion:
Transient constriction of the fetal ductus arteriosus and the resultant changes on fetal echocardiogram is a well-described phenomenon following maternal exposure to indomethacin. If serial fetal monitoring remains reassuring despite the evidence of new fetal hydrops, it may be reasonable for the team to monitor, rather than proceed to delivery, due to evidence of spontaneous resolution of ductal constriction following indomethacin cessation.
{{ help_message }}
{{filter}}