Indomethacin embryofetopathy

Indomethacin embryofetopathy (also known as fetal indomethacin syndrome) is a rare condition resulting from prenatal exposure to indomethacin, a nonsteroidal anti-inflammatory drug (NSAID) that inhibits prostaglandin synthesis. Indomethacin is sometimes used during pregnancy to manage preterm labor or polyhydramnios, but its use—particularly in the second and third trimesters—can adversely affect fetal development. This is not a genetic disorder but rather a teratogenic condition caused by medication exposure during critical periods of fetal development. The condition primarily affects the cardiovascular, renal, and gastrointestinal systems of the developing fetus. Key clinical features include premature constriction or closure of the ductus arteriosus, which can lead to persistent pulmonary hypertension of the newborn. Renal effects may include oligohydramnios (reduced amniotic fluid), neonatal renal insufficiency or failure, and oliguria. Gastrointestinal complications such as necrotizing enterocolitis and intestinal perforation have also been reported. Additional findings may include intracranial hemorrhage and other bleeding complications related to impaired platelet function. Management is primarily preventive, involving careful consideration of the risks and benefits before prescribing indomethacin during pregnancy, limiting duration of use, and monitoring fetal well-being with echocardiography and amniotic fluid assessment. When neonatal complications arise, treatment is supportive and symptom-directed, potentially including management of pulmonary hypertension, renal support, and surgical intervention for gastrointestinal complications. Prognosis depends on the severity and combination of organ involvement.

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