Severe oligohydramnios induced by cyclooxygenase-2 inhibitor nimesulide

Background: Cyclooxygenase-2 inhibitors might have fewer adverse fetal effe cts than conventional nonsteroidal antiinflammatory drugs that inhibit both isoforms of the enzyme. Although cyclooxygenase-2 is expressed in fetal ki dneys, there are no reports of adverse effects in human pregnancy. Case: A 27-year-old woman, gravida 2 para 0,with a twin pregnancy at 24 wee ks' gestation had placement of a cervical cerclage. Nimesulide was prescrib ed for postoperative preterm labor prophylaxis. Three weeks later, severe o ligohydramnios was identified in both sacs, despite normal growth, renal an atomy, and umbilical artery and renal artery Doppler now velocimetry. After stopping the drug, amniotic fluid volumes returned to normal over 2 weeks. There were no adverse neonatal renal effects. Conclusion: Selective cyclooxygenase-2 inhibition might cause severe oligoh ydramnios. If it is used, we advise close fetal surveillance. (Obstet Gynec ol 2000;96:810-1. 0 2000 by The American College of Obstetricians and Gynec ologists.).