Terminal transverse limb defects with tethering and omphalocele in a 17 week fetus following first trimester misoprostol exposure

We report a fetus from an elective termination at 17 weeks gestation follow ing maternal ingestion of 1200 mu g of misoprostol at 7 weeks of gestation. The fetus had abscence of the middle and distal phalanges of fingers 1, 3, 4 and 5 with tethering by thin strands of tissue on one hand, a below-knee amputation of one leg and omphalocele. There was absence of amnion on the chorionic surface of the placenta, a pathologic feature of early amnion rup ture. The association in this case of the phenotypic features of the amniot ic band syndrome suggests that the teratogenicity of misoprostol at 9 to 12 weeks gestation can overlap that of other acute insults at that time, such as chorionic villus sampling, dilatation and curettage and abdominal traum a in the first trimester. Clin Dysmorphol 8: 53-58 (C) 1999 Lippincott Will iams & Wilkins.