INDOMETHACIN AND FETAL DUCTUS-ARTERIOSUS - COMPLETE CLOSURE AFTER CESSATION OF PROLONGED THERAPEUTIC COURSE

Indomethacin is a very effective tocolytic agent. However, concern abo ut its possible constrictive effect on fetal ductus arteriosus has lim ited the use of this medication in pregnancy. A 29-year-old woman was treated with indomethacin at 27 weeks of gestation for preterm labor a nd polyhydramnios. She received a dose of 75 mg/day for 5 weeks. At 35 weeks of gestation, she had a cesarean delivery due to fetal distress , and a hydropic baby was delivered. The infant died shortly after. No nimmune hydrops fetalis and closed ductus arteriosus were the only pat hological findings at autopsy. In utero, irreversible, complete closur e of the ductus arteriosus is very rare. In the case presented, prolon ged use of indomethacin during pregnancy was associated with complete closure of the ductus arteriosus that developed most probably after di scontinuation of therapy. This case emphasizes the need for frequent f etal echocardiography examinations during as well as after maternal in domethacin treatment.