Doppler assessment of the pulsatility index of the middle cerebral artery during constriction of the fetal ductus arteriosus after indomethacin therapy

Article Abstract:

Indomethacin is a nonsteroidal anti-inflammatory agent which can be used to treat pregnancy complications, such as early labor and excess fluid surrounding the fetus. Indomethacin can cause constriction of the blood vessel communicating between the fetal heart and lungs, the ductus arteriosus. It is thought that while the ductus arteriosus is constricting, the blood vessels in the brain dilate. Doppler ultrasonography uses high frequency sound to examine blood flow through blood vessels. Doppler assessments of the cerebral artery in the brain were obtained in 13 fetuses before and after indomethacin administration. Constriction of the ductus arteriosus was revealed in 11 fetuses two days after indomethacin treatment and in two fetuses one week after treatment. The tricuspid valve of the heart (normally a one-way valve between the right atrium and the right ventricle) became inefficient, permitting backflow of blood in six of the 13 fetuses. When the medication was discontinued, the constricted ductus arteriosus returned to normal. Fetuses experiencing both ductus arteriosus constriction and tricuspid valve backflow simultaneously had lower doppler assessments in the cerebral artery of the brain than the other fetuses. These results suggest that indomethacin produces increased blood flow to the brain in the presence of ductus arteriosus constriction. Similar Doppler results are found in fetuses experiencing hypoxia, a lack of oxygen in the blood. Fetuses having Doppler assessments that indicate an increased blood flow to the brain should be evaluated for ductus constriction and tricuspid valve insufficiency. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Usage, Hydramnios, Doppler ultrasonography, Blood circulation

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Placental transfer of indomethacin in the human pregnancy

Article Abstract:

Indomethacin, a nonsteroidal anti-inflammatory drug (NSAID), is used to reduce swelling and can also be used to treat premature labor. Indomethacin can cause premature closure of the ductus arteriosus, a communication of blood vessels in the fetal circulation that closes when the infant takes in air immediately after birth. Since this complication occurs primarily in patients receiving long-term administration after 34 weeks of pregnancy, it is recommended that indomethacin not be used after 36 weeks. It is suggested that the drug does not cause complications before 36 weeks because of poor transfer of the drug through the placenta. To study the transfer of indomethacin to the fetus, 26 pregnant women had umbilical cord blood sampled six hours after indomethacin (50 mg) administration. Although indomethacin levels were slightly higher in the mother, the maternal/fetal ratio of indomethacin was similar throughout pregnancy. Therefore, indomethacin crosses the placenta throughout pregnancy. Only a small amount of unchanged indomethacin is found to be excreted by the fetus into the amniotic fluid which surrounds it. It is thought that as the infant approaches term, it becomes more sensitive to the ability of indomethacin to narrow blood vessels. (Consumer Summary produced by Reliance Medical Information, Inc.)

Maternal-fetal exchange, Fetus, Physiological aspects

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