title: Diagnosis and management of fetal ductus arteriosus constriction-closure.
abstract: Pathognomonic features of in utero premature restriction/closure of the ductus arteriosus (DA) are increased right ventricular afterload, impaired right ventricular function, and consequently tricuspid regurgitation and right heart dilation. The most common reason for constriction-closure of DA is maternal administration of non-steroidal anti-inflammatory drugs (NSAIDs) during the 3rd trimester of gestation. The idiopathic form is a rare event and, maybe, an underestimated abnormality that, if it is not promptly recognized, may result in severe fetal-neonatal compromise. We describe a case of a 38-year-old woman presenting at 34 +0 weeks of gestation with a normally grown male fetus whose fetal echocardiography had shown right ventricular hypertrophy, a tortuous S-shaped DA and a significant pulmonary hyperflow. All signs were consistent of an idiopathic severe constriction of DA with a significant fetal cardiac involvement. The patient was admitted to a tertiary care center equipped with Neonatal Intensive Care Unit (NICU), and delivered by cesarean section at 34 +4 weeks with a good maternal and neonatal outcome. Based on our experience and a review of the Literature we propose a management algorithm to use when dealing with preterm or early term pregnancy complicated by this fetal hemodynamic malfunction.
authors.affiliation: Institute of Obstetric and Gynecologic Pathology, Department of Surgery, Division of Obstetrics and Gynecology, S. Bambino Hospital, University of Catania, Catania, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Genovese
authors.affiliation: Institute of Obstetric and Gynecologic Pathology, Department of Surgery, Division of Obstetrics and Gynecology, S. Bambino Hospital, University of Catania, Catania, Italy.
authors.forename: I
authors.initials: I
authors.lastname: Marilli
authors.affiliation: Complex Operative Unit of Prenatal Diagnosis and Medical Genetics, University Hospital Vittorio Emanuele, Catania, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Benintende
authors.affiliation: Department of Paediatric Cardiology, S. Bambino Hospital, University of Catania, Catania, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Privitera
authors.affiliation: Institute of Obstetric and Gynecologic Pathology, Department of Surgery, Division of Obstetrics and Gynecology, S. Bambino Hospital, University of Catania, Catania, Italy.
authors.forename: F A
authors.initials: FA
authors.lastname: Gulino
authors.affiliation: Institute of Obstetric and Gynecologic Pathology, Department of Surgery, Division of Obstetrics and Gynecology, S. Bambino Hospital, University of Catania, Catania, Italy.
authors.forename: I
authors.initials: I
authors.lastname: Iozza
authors.affiliation: Department of Pediatrics, University of Catania, Catania, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Cimino
authors.affiliation: Institute of Obstetric and Gynecologic Pathology, Department of Surgery, Division of Obstetrics and Gynecology, S. Bambino Hospital, University of Catania, Catania, Italy.
authors.forename: M A
authors.initials: MA
authors.lastname: Palumbo
keywords: Ductus arteriosus; fetal pulmonary hyperflow; fetal ventricular afterload; fetal ventricular hypertrophy; fetal ventricular overload