PREMATURE CLOSURE OF THE DUCTUS ARTERIOSUS: VARIABLE RESPONSE AMONG MONOZYGOTIC TWINS AFTERIN UTEROEXPOSURE TO INDOMETHACIN

Abstract

Exposure of the fetus to indomethacin by administration of the drug to the mother may cause many side effects, including premature closure of the ductus arteriosus. Hypoxia is a predisposing factor for premature ductal closure and often occurs after maternal indomethacin therapy. We present two sets of monozygotic twins with twin-to-twin transfusion, where in utero ductal closure occurred in the donor twin while the recipient twin appeared unaffected. This selective closure of the ductus arteriosus suggests that the affected twin was predisposed to hypoxia and thus was more susceptible to ductal closure in response to indomethacin exposure.

Are complicated monochorionic twins more susceptible to indomethacin-induced fetal ductal constriction? Two cases of laser surgery for Twin-Twin Transfusion syndrome

“…In our opinion, this effect was observed only in the donor twins because of the relatively hypoxic conditions of donor foetuses. A selective constrictive effect of indomethacin on MC twins has been shown previously in some pathologically proven reports ( 8 ) . Furthermore, indomethacin can decrease fetal urine output and lead to deterioration in amniotic fluid levels in the donor foetus.…”

Assessment of drug induced developmental toxicity using human embryonic stem cells

“…Furthermore, implementation of the EST in regulatory test guidelines would demonstrate the importance of in vitro assays as valuable components of the risk/hazard assessment process. Based on animal studies, embryocidal, multiple abnormalities (Villani et al, 1996) 3 Caffeine 20e55 81.6 Cardiac, CNS Skeletal defects, retarded growth and low birth weight (Pesce et al, 1998) 4 Indomethacin 0.5e1 4.49 Cardiac, Renal Premature closure of ductus arteriosus (Shehata et al, 2006;Hvidberg et al, 1972) 5 Penicillin G 300e500 1300 Hypersensitivity None in humans (Penicillin G) 6…”

“…All values are in mg/ml. (Shehata et al, 2006;Hvidberg et al, 1972) 5 Penicillin G 300e500 1300 Hypersensitivity None in humans (Penicillin G) 6…”

Regulation of progesterone receptor A and B expression in human preterm, term, and postterm placental villi

“…Prostaglandin preparations are used clinically for cervical ripening and induction of labor and in the management of postterm pregnancies (9) and abortions (10). Indomethacin is a strong inhibitor of prostaglandin synthesis and has been widely used for its tocolytic effect, yet its use has declined (11) due to possible fetal side effects (12). However, it represented a suitable agent for exploring the effects of prostaglandin inhibition on PR ratio and labor regulation in this experimental study.…”