Fetal ductus arteriosus constriction and closure: analysis of the causes and perinatal outcome related to 45 consecutive cases

Lopes, Lílian Maria; Carrilho, Milene Carvalho; Francisco, Rossana Pulcineli Vieira; Lopes, Marco Antônio Borges; Krebs, Vera Lúcia Jornada; Zugaib, Marcelo

doi:10.3109/14767058.2015.1015413

Cited by 54 publications

(61 citation statements)

References 23 publications

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“…In this case series analysis, we retrieved and discussed 25 cases of fetal ductus arteriosus constriction or closure, and thereby provided evidence on the likely causal relationship with maternal paracetamol intake. Although robust data on its incidence are absent, fetal ductus arteriosus constriction or closure is rare, with two recent retrospective case series on, respectively, 45 and 22 consecutive cases in datasets of 26 000 (0.17%) and 1602 (1.4%) referrals for fetal echocardiography [20,27]. The specific setting of fetal physiology necessitates patency of the fetal ductus arteriosus to bypass fetal blood flow from the pulmonary artery to the systemic circulation under low pressure and low resistance settings.…”

Section: Discussionmentioning

confidence: 99%

Maternal paracetamol intake and fetal ductus arteriosus constriction or closure: a case series analysis

Allegaert

Mian

Lapillonne

et al. 2018

Brit J Clinical Pharma

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Recent case reports describe an association between maternal paracetamol intake and fetal ductus arteriosus constriction or closure. To put these cases into perspective and explore causality, a structured literature search was conducted. The World Health Organization Uppsala Monitoring Centre (WHO–UMC) causality tool was applied to the cases retrieved. The search resulted in 12 papers with 25 case descriptions, of which one case was classified as unlikely, nine as possible, 11 as probable and four as certain. Consequently, we concluded that a causal relationship between maternal paracetamol intake and fetal ductus arteriosus constriction or closure is likely. These findings suggest that pharmacovigilance studies on paracetamol safety during pregnancy are warranted to quantify the event and put the current findings into clinical perspective. Although analgesia during pregnancy and during the peripartum period is of obvious relevance, alternative analgesics such as opioids or other nonsteroidal anti‐inflammatory drugs also have side effects.

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Section: Discussionmentioning

confidence: 99%

Maternal paracetamol intake and fetal ductus arteriosus constriction or closure: a case series analysis

Allegaert

Mian

Lapillonne

et al. 2018

Brit J Clinical Pharma

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“…60 The right ventricular Tei index is increased in ductal constriction secondary to shortened ejection time, and returns to baseline coincident with ductal relaxation. 59 Tricuspid regurgitation is often seen and can be used to establish that high right ventricular systolic pressure is present.…”

Section: Ductal Constrictionmentioning

confidence: 98%

Cardiac function and dysfunction in the fetus

Eckersley

Hornberger

2017

Echocardiography

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Evaluation of fetal cardiac function is one of the most important components of fetal echocardiography. Fetal cardiac dysfunction is closely linked to risk of intrauterine fetal demise, in many, but not all cases is indicative of worse postnatal prognosis and may prompt the use of medications or interventions to optimize outcomes. There may be implications for termination versus continuation of pregnancy, an indication for early delivery, a change in location and even mode of delivery. In extreme cases, fetal cardiac dysfunction may prompt prenatal or early neonatal listing for cardiac transplantation. There are several important differences between the fetal and postnatal circulatory physiology which affect echocardiographic assessment of cardiac dysfunction. In this review, we examine the echocardiographic findings according to their underlying pathophysiology with reference to common causes.

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“…Postnatal management should focus on therapies to reduce PVR which will improve right heart hemodynamics and lead to less right-to-left PFO shunting and cyanosis. Fetuses that can escape this neonatal period without extreme prematurity, hydrops, or RV failure have good long-term prognosis [9,10].…”

Section: Discussionmentioning

confidence: 99%