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Drug induced closure of patent ductus arteriosus.

Closure ofthe fetal arterial duct The arterial duct of the fetus is undoubtedly sensitive to prostaglandin synthetase inhibitors administered to the mother. These drugs may be taken by pregnant women for any of their standard uses and may specifically be prescribed to halt the progression of polyhydramnios, or to suppress labour. Persistent pulmonary hypertension in the newborn has been reported with fetal exposure to prostaglandin synthetase inhibitors' 2; however, this finding was not confirmed in larger series.3 Fetal duct closure and changes induced directly in the pulmonary vasculature by the drug are postulated in the genesis of pulmonary hypertension.3 Reversible constriction of the fetal duct during maternal indomethacin therapy is well described.4 It seems appropriate to recommend that the fetuses of mothers who are receiving this group of drugs should be assessed by serial echocardiography. This is particularly desirable when polyhydramnios is the clinical problem, as this may be associated with a number of congenital abnormalities which themselves are associated with an increased incidence of structural congenital heart disease in the fetus. Administration of a duct-constricting drug to a fetus with duct-dependent heart disease should ideally be avoided, but at the very least it should not be done in ignorance and its effects should be monitored carefully by ultrasound imaging and Doppler assessments.