Pediatric Cardiology

, Volume 34, Issue 8, pp 1925–1927 | Cite as

Maternal Diclofenac Medication in Pregnancy Causing in Utero Closure of the Fetal Ductus Arteriosus and Hydrops

  • Aravind T. Shastri
  • Dalia Abdulkarim
  • Paul ClarkeEmail author
Case Report


This report describes a case of premature closure in utero of the ductus arteriosus (DA) diagnosed postnatally in a baby with hydrops and cardiac failure. An echocardiogram 6 h postnatally showed marked dilation of the right atrium and right ventricle with marked hypertrophy and impaired function, elevated pulmonary pressures, a small pericardial effusion, and no flow through the DA. The mother was unaware of her pregnancy until she presented in labor, and she had taken diclofenac medication in the preceding months. This case and the accompanying literature review illustrate the potential fetal and neonatal complications resulting from antenatal closure of the DA due to maternal diclofenac medication during pregnancy.


Ductus arteriosus Premature closure Diclofenac Neonatal Hydrops 



The authors thank Dr. Ian Sullivan, Consultant Cardiologist, for helpful comments on the case, Les Samuels, Advanced Practitioner Ultrasound, for reviewing the antenatal images and Sheila Wood, Principal Cardiology Technician, for providing the neonatal echocardiogram images.

Conflict of interest


Supplementary material

Movie clip 1: Echocardiographic short-axis view showing RVH with a compressed “D”-shaped left ventricle. (MOV 820 kb)

Movie clip 2: Echocardiographic parasternal short-axis view showing the RV outflow tract on 2D imaging. (MOV 965 kb) (296 kb)
Movie clip 3: Echocardiographic parasternal short-axis view showing the RV outflow tract and no evidence of ductal flow on color Doppler imaging. (MOV 296 kb)


  1. 1.
    Auer M, Brezinka C, Eller P et al (2004) Prenatal diagnosis of intrauterine premature closure of the ductus arteriosus following maternal diclofenac application. Ultrasound Obstet Gynecol 23:513–516CrossRefPubMedGoogle Scholar
  2. 2.
    Dudley DK, Hardie MJ (1985) Fetal and neonatal effects of indomethacin used as a tocolytic agent. Am J Obstet Gynecol 151:181–184CrossRefPubMedGoogle Scholar
  3. 3.
    Gewillig M, Brown SC, De Catte L et al (2009) Premature fetal closure of the arterial duct: clinical presentations and outcome. Eur Heart J 30:1530–1536CrossRefPubMedGoogle Scholar
  4. 4.
    Hofstadler G, Tulzer G, Altmann R, Schmitt K, Danford D, Huhta JC (1996) Spontaneous closure of the human fetal ductus arteriosus: a cause of fetal congestive heart failure. Am J Obstet Gynecol 174:879–883CrossRefPubMedGoogle Scholar
  5. 5.
    Ishida H, Inamura N, Kawazu Y, Kayatani F (2011) Clinical features of the complete closure of the ductus arteriosus prenatally. Congenit Heart Dis 6:51–56CrossRefPubMedGoogle Scholar
  6. 6.
    Mas C, Menahem S (1999) Premature in utero closure of the ductus arteriosus following maternal ingestion of sodium diclofenac. Aust NZ J Obstet Gynaecol 39:106–107CrossRefGoogle Scholar
  7. 7.
    Menahem S (1991) Administration of prostaglandin inhibitors to the mother; the potential risk to the fetus and neonate with duct dependent circulation. Reprod Fertil Dev 3:489–494CrossRefPubMedGoogle Scholar
  8. 8.
    Nirmal D, Thijs I, Bethel J, Bhal P (2006) The incidence and outcome of concealed pregnancies among hospital deliveries: an 11-year population-based study in South Glamorgan. J Obstet Gynaecol 26:118–121CrossRefPubMedGoogle Scholar
  9. 9.
    Rasanen J, Wood DC, Weiner S, Ludomirski A, Huhta JC (1996) Role of the pulmonary circulation in the distribution of human fetal cardiac output during the second half of pregnancy. Circulation 94:1068–1073CrossRefPubMedGoogle Scholar
  10. 10.
    Rein AJJT, Nadjari M, Elchalal U, Nir A (1999) Contraction of the fetal ductus arteriosus induced by diclofenac. Fetal Diagn Ther 14:24–25CrossRefPubMedGoogle Scholar
  11. 11.
    Siu KL, Lee WH (2004) Maternal diclofenac sodium ingestion and severe neonatal pulmonary hypertension. J Paediatr Child Health 40:152–153CrossRefPubMedGoogle Scholar
  12. 12.
    Tulzer G, Gudmundsson S, Tews G, Wood DC, Huhta JC (1992) Incidence of indomethacin-induced human fetal ductal constriction. J Matern Fetal Invest 1:267–269CrossRefGoogle Scholar
  13. 13.
    Vermillion ST, Scrado JA, Lashus AG, Wiles HB (1997) The effect of indomethacin tocolysis on fetal ductus arteriosus constriction with advancing gestational age. Am J Obstet Gynecol 177:256–261CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Aravind T. Shastri
    • 1
  • Dalia Abdulkarim
    • 1
  • Paul Clarke
    • 1
    Email author
  1. 1.Neonatal Intensive Care UnitNorfolk & Norwich University Hospitals NHS Foundation TrustNorwichUK

Personalised recommendations