title: Fetal warfarin syndrome.
abstract: A case of a baby born preterm with an antenatal diagnosis of aortic coarctation for which prostin was electively started at birth. The baby was found to be profoundly anaemic with no clear obstetric cause. Features consistent with antenatal intracerebral haemorrhage were noted on cranial ultrasonography in the context of severe coagulopathy, prompting investigations which confirmed fetal-maternal haemorrhage. It transpired that, following aortic and mitral valve replacements, the mother was anticoagulated with warfarin at conception, having misunderstood her cardiologist's advice that: 'you cannot get pregnant whilst on warfarin'. Following conversion to low molecular weight heparin, she suffered a stroke, thus warfarin was restarted, with an international normalised ratio of 3-4.7 during pregnancy. Following transfer to the paediatric intensive care unit, fetal warfarin syndrome was diagnosed. The coagulopathy and anaemia were corrected and aortic coarctation was excluded. The baby returned to the neonatal intensive care unit for ongoing care and was discharged home in good condition around his due date. At the present time, there is no clinically overt neurological deficit.
authors.affiliation: Department of Paediatric Cardiology, Royal Brompton & Harefield NHS Trust, London, UK. l.starling@rbht.nhs.uk
authors.forename: Luke D
authors.initials: LD
authors.lastname: Starling
authors.forename: Ashutosh
authors.initials: A
authors.lastname: Sinha
authors.forename: Duncan
authors.initials: D
authors.lastname: Boyd
authors.forename: Anke
authors.initials: A
authors.lastname: Furck
mesh_terms: D000014:Abnormalities, Drug-Induced / Q000188:drug therapy / Q000209:etiology*; D000740:Anemia / Q000139:chemically induced* / Q000188:drug therapy; D000925:Anticoagulants / Q000009:adverse effects*; D001017:Aortic Coarctation / Q000139:chemically induced* / Q000188:drug therapy; D001777:Blood Coagulation; D001778:Blood Coagulation Disorders / Q000209:etiology*; D005260:Female; D005315:Fetal Diseases / Q000139:chemically induced / Q000188:drug therapy; D006351:Heart Valves / Q000601:surgery; D006470:Hemorrhage / Q000209:etiology; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008431:Maternal-Fetal Exchange; D009295:Nasal Bone / Q000002:abnormalities*; D011183:Postoperative Complications / Q000517:prevention & control; D011247:Pregnancy; D047928:Premature Birth; D020521:Stroke / Q000139:chemically induced / Q000150:complications; D014859:Warfarin / Q000009:adverse effects*
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D014859:Warfarin