title: Hemodynamic assessment of indomethacin-induced fetal heart failure in high-output state.
abstract: Hemodynamic study was performed on a 32-year-old woman presenting at 27 weeks' gestation. Ultrasound revealed a single normal fetus with mild cardiomegaly, polyhydramnios, and placental chorioangioma. Doppler study showed increased middle cerebral artery peak systolic velocity, normal Tei index, and forward flow of "a" wave with normal preload in the ductus venosus. Twelve hours after initiation of indomethacin for tocolysis, frank hydrops fetalis developed rapidly. The right ventricle showed poor contractility and performance. Markedly increased preload in ductus venosus with reversed "a" wave and pulsations in the umbilical vein were demonstrated. This study suggests that indomepacin treatment in fetal high-cardiac output state should be used with extreme caution.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Thailand.
authors.forename: Theera
authors.initials: T
authors.lastname: Tongsong
authors.forename: Suchaya
authors.initials: S
authors.lastname: Luewan
authors.forename: Kasemsri
authors.initials: K
authors.lastname: Srisupundit
authors.forename: Thanate
authors.initials: T
authors.lastname: Jatavan
mesh_terms: D000328:Adult; D005260:Female; D006333:Heart Failure / Q000139:chemically induced / Q000000981:diagnostic imaging*; D006391:Hemangioma / Q000000981:diagnostic imaging; D006439:Hemodynamics; D006801:Humans; D015160:Hydrops Fetalis / Q000139:chemically induced / Q000000981:diagnostic imaging*; D007213:Indomethacin / Q000009:adverse effects*; D007231:Infant, Newborn; D010922:Placenta Diseases / Q000000981:diagnostic imaging; D011247:Pregnancy; D015149:Tocolytic Agents / Q000009:adverse effects*; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal
chemical_list: D015149:Tocolytic Agents; D007213:Indomethacin
keywords: Doppler; chorioangioma; heart failure; hydrops fetalis; indomethacin; prenatal diagnosis; sonography