The role of ultrasound in the early diagnosis of fetal structural defects following maternal anticonvulsant therapy.
A total of 162 pregnant subjects using anticonvulsant drugs were examined for fetal congenital defects over a period of five years. In 138 of these subjects, alpha-feto-protein (AFP) levels were determined in amniotic fluid at 16 weeks of gestation to rule out spina bifida. In all instances, a fetal anomaly scan was performed between 18 and 20 weeks of gestation. AFP levels were always within the normal range; neonatal examination revealed no spina bifida; however, in seven newborns, a single, or multiple structural defect was established. Apart from cases of severe hydrocephaly, hypospadia, and radius aplasia, the anomalies were too small to be detected by present-day ultrasound equipment. Couples should be informed of the limitations of ultrasound in the early detection of structural defects previously associated with the use of anticonvulsant drugs.
Wladimiroff
J W
JW
Department of Obstetrics and Gynaecology, Academic Hospital Rotterdam-Dijkzigt, Erasmus University Rotterdam, The Netherlands.
Stewart
P A
PA
Reuss
A
A
van Swaay
E
E
Lindhout
D
D
Sachs
E S
ES
D000014:Abnormalities, Drug-Induced / Q000175:diagnosis*; D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use*; D002220:Carbamazepine / Q000009:adverse effects / Q000627:therapeutic use; D003975:Diazepam / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008431:Maternal-Fetal Exchange; D008875:Middle Aged; D010634:Phenobarbital / Q000009:adverse effects / Q000627:therapeutic use; D010672:Phenytoin / Q000009:adverse effects / Q000627:therapeutic use; D011247:Pregnancy; D011296:Prenatal Diagnosis; D011446:Prospective Studies; D014463:Ultrasonography; D014635:Valproic Acid / Q000009:adverse effects / Q000627:therapeutic use
D000927:Anticonvulsants; D002220:Carbamazepine; D014635:Valproic Acid; D010672:Phenytoin; D003975:Diazepam; D010634:Phenobarbital