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A Journal on Obstetrics and Gynecology

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Minerva Ginecologica 1999 May;51(5):197-202

language: Italian

Timely detection of premature closure of the fetal ductus arteriosus in full-term pregnancy: crucial role of fetal echocardiography

Tumbarello R., Pisu F., Pisano E. Puddu R., Bini R. M.


Patency of the ductus arteriosus (DA) is maintained during gestation by locally produced and circulating prostaglandins (PGE's). As gestation proceeds, the ductus becomes less sensitive to dilating prostaglandins and more sensitive to constricting factors such as PGE's synthetase inhibitors. This case report describes a fetus at term (38 weeks) with signs of severe right ventricular failure due to constriction of DA. Maternal history documented 5 day assumption of a non-steroid antinflammatory agent to relieve skeletal-muscle pain. Careful echocardiogram rouled out a structural heart disease, such as coarctation of the aorta. A gradient of 41 mmHg across the ductus was recorded. A cesarean section delivery was immediately undertaken. The 3.5 kg newborn delivered appeared to be in good health, with Apgar score of 8/9 at 1 and 5'. There were no signs of congestive heart failure and mild respiratory distress. An echocardiogram showed a dilated, well contractile right ventricle, with a pressure of 50 mmHg. DA was already closed. The fetal echocardiogram was the most relevant investigation in the decision-making process of this case treatment. Any different evaluation of this fetal heart, delaying the delivery would have very seriously compromised the survival of the fetus. Fetal echocardiography is the most important diagnostic tool in the evaluation of the fetal heart; non steroid antinflammatory drugs to mother at term should be avoided or given with close echocardiographic assessment of DA patency.

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