warfarin and Abnormalities--Multiple

Topics: Abnormalities, Drug-Induced; Abnormalities, Multiple; Calcinosis; Diagnosis, Differential; Epiphyses; Female; Fetal Diseases; Humans; Infant, Newborn; Nose; Pregnancy; Prenatal Exposure Delayed Effects; Prognosis; Syndrome; Vitamin K Deficiency; Warfarin

Topics: Abnormalities, Drug-Induced; Abnormalities, Multiple; Animals; Female; Fetal Death; Heart Valve Prosthesis; Humans; Infant, Newborn; Pregnancy; Pregnancy Complications, Cardiovascular; Warfarin

Fetal exposure to maternal ingestion of warfarin is known to produce certain dysmorphic features in the neonate, known as fetal warfarin syndrome (FWS). There is a general consensus that maternal intake of warfarin at a daily dose of 5 mg or less is safe both for the infant and the mother.. We report four cases of FWS born to mothers with rheumatic heart disease on warfarin prophylaxis during pregnancy at a dose less than 5 mg/day.. Along with typical facial features of FWS and multiple epiphyseal stippling in skeletal x-ray, Case 1 had Dandy-Walker malformation and Case 2 had laryngo-tracheomalacia and patent ductus arteriosus.. We emphasize the need for optimizing the choice and dosage schedule of anticoagulants during pregnancy, least harmful for the mother and her developing fetus.

Topics: Abnormalities, Drug-Induced; Abnormalities, Multiple; Adult; Anticoagulants; Dandy-Walker Syndrome; Ductus Arteriosus, Patent; Female; Heart Valve Prosthesis; Humans; Nasal Bone; Pregnancy; Prenatal Exposure Delayed Effects; Rheumatic Heart Disease; Warfarin

Di Sala syndrome or fetal warfarin syndrome/fetal warfarin embryopathy is a rare condition as result of fetal exposure due to maternal ingestion of warfarin during pregnancy. The authors report here a male infant with this condition whose mother was suffering from rheumatic mitral valvular heart disease for which she underwent prosthetic mitral valvular replacement surgery and put on injectable long acting penicillin and oral low-molecular weight anticoagulant drug (warfarin) for life long. The patient presented with facial dysmorphism, pectus excavatum, stippled epiphyses dolichocephaly, brachydactyly, polydactyly short neck and growth retardation. Shortened fourth metacarpal bones were also noted in this case which was not yet reported in literatures, to the best of our knowledge.

Topics: Abnormalities, Drug-Induced; Abnormalities, Multiple; Anticoagulants; Diagnosis, Differential; Female; Humans; Infant; Male; Pregnancy; Prenatal Exposure Delayed Effects; Syndrome; Warfarin

Warfarin, which is used for anticoagulant therapy, rarely produces congenital warfarin syndrome characterized with hypoplastic nose, stippled epiphyses, and skeletal abnormalities when ingested during pregnancy. Here, we present a male infant, whose mother was treated with warfarin because of a prosthetic heart valve replacement after rheumatic heart disease, with signs of warfarin embryopathy. The mother's first pregnancy at 12 weeks gestation resulted in abortus due to warfarin toxicity. Subsequently, she delivered two healthy girls after her treatment had changed to low molecular heparin during pregnancy periods. We want to emphasize that risk-benefit ratio should be well weighed by both obstetricians and cardiologists when considering warfarin therapy for a woman at childbearing age.

Topics: Abnormalities, Drug-Induced; Abnormalities, Multiple; Anticoagulants; Female; Heart Valve Prosthesis; Humans; Infant, Newborn; Male; Mothers; Nasal Bone; Pregnancy; Prenatal Exposure Delayed Effects; Warfarin

Topics: Abnormalities, Multiple; Anticoagulants; Bioprosthesis; Cardiac Surgical Procedures; Drug Administration Schedule; Female; Follow-Up Studies; Heart Defects, Congenital; Heart Septal Defects, Ventricular; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Infant; Postoperative Care; Thromboembolism; Time Factors; Treatment Outcome; Tricuspid Valve Insufficiency; Warfarin

We describe a pair of twins, whose mother was being treated by oral anticoagulant drugs, as a result of having received mitral heart valve implantation in the past. The male twins monochorionic, monoamniotic--but one infant showed the features of fetal warfarin syndrome. In the study we discussed the pharmacogentetics and individual variation in the human metabolism during treatment with warfarin-perinatal growth and prevalence of congenital malformations. We analysed the threats to the fetus and mother, connected with administration of anticoagulant drugs.

Topics: Abnormalities, Multiple; Adult; Anticoagulants; Diseases in Twins; Female; Fetal Death; Humans; Infant, Newborn; Male; Mitral Valve Insufficiency; Pregnancy; Pregnancy Complications, Cardiovascular; Prenatal Exposure Delayed Effects; Twins; Warfarin

Fetal warfarin syndrome (FWS) or warfarin (coumadin) embryopathy is a rare condition as a result of fetal exposure to maternal ingestion of warfarin during pregnancy. A male infant, whose mother was treated with the anticoagulant (warfarin) because of a mechanical heart valve replacement after rheumatic heart disease, presented with signs of warfarin embryopathy. The facial dysmorphism included hypoplasia of nasal bridge, laryngomalacia, pectus carinatum, congenital heart defects (atrial septal defect and patent ductus arteriosus), ventriculomegaly, stippled epiphyses, telebrachydactyly, and growth retardation. The pathogenesis and management of FWS are discussed.

Topics: Abnormalities, Drug-Induced; Abnormalities, Multiple; Anticoagulants; Female; Growth and Development; Heart Defects, Congenital; Humans; Infant; Infant, Newborn; Infant, Premature; Male; Maternal Exposure; Nose; Pregnancy; Prenatal Exposure Delayed Effects; Warfarin

A child with macrocephaly-cutis marmorata developed severe abdominal pain thought to represent mesenteric angina. There were abnormalities of the aortic and mesenteric vasculature not previously reported in this condition. Angina therapy afforded amelioration of his symptoms. Mesenteric angina should be considered as a cause for abdominal pain in children with mesodermal anomalies.

Topics: Abdominal Pain; Abnormalities, Multiple; Adolescent; Angiography; Anorexia; Brain; Humans; Infant, Newborn; Infarction; Kidney; Male; Mesenteric Arteries; Mesoderm; Spleen; Venous Thrombosis; Warfarin

Topics: Abnormalities, Drug-Induced; Abnormalities, Multiple; Female; Humans; Infant, Newborn; Pregnancy; Pregnancy Complications, Cardiovascular; Rheumatic Heart Disease; Warfarin

The Obstetric Drug Information Service at the Queen Victoria Medical Center in Melbourne, Australia aims to provide relevant information relating to drug use in pregnancy. A preliminary study conducted by the Center revealed that 62.5% of pregnant women consumed drugs during their pregnancies (excluding iron and vitamins), with an average of 3 drugs per woman. Certain drugs are relatively safer than others, and the selection of the appropriate drug for a pregnant patient is very important to the future health and well-being of the child. At least 5% of all birth defects are drug induced. The drugs that produce fetal abnormalities are called "dysmorphogens" or "teratogens". General principles of drug use in pregnancy are outlined. These include the following: 1) no drug should be considered 100% safe to the developing fetus, including topical preparations; 2) a true indication must be present for the administration of any drug; 3) the potential benefits should always be weighed against the possible hazards of that drug to the mother and the fetus; and 4) the effect of a drug on the fetus may not necessarily be the same as the intended pharmacological effect on the mother. The following specific drug induced embryopathies are reviewed: fetal alcohol syndrome; Warfarin syndrome; fetal hydantoin syndrome; stilbestrol (diethylstilbestrol, DES) syndrome, VACTERL syndrome, and thalidomide embryopathy. Drugs which are safe for use in pregnancy are analgesics, hypnosedatives, antibiotics, antiemetics and antihistamines, psychotherapeutic drugs, antihypertensive drugs, antituberculous drugs, antimalarial drugs, antithyroid drugs, and antidiabetic drugs.

Topics: Abnormalities, Drug-Induced; Abnormalities, Multiple; Analgesics; Anti-Bacterial Agents; Antiemetics; Antihypertensive Agents; Antimalarials; Antitubercular Agents; Diethylstilbestrol; Drug-Related Side Effects and Adverse Reactions; Female; Fetal Alcohol Spectrum Disorders; Fetus; Histamine H1 Antagonists; Humans; Hydantoins; Hypnotics and Sedatives; Hypoglycemic Agents; Infant, Newborn; Pregnancy; Pregnancy Complications; Psychotropic Drugs; Warfarin

Topics: Abnormalities, Drug-Induced; Abnormalities, Multiple; Adult; Female; Heart Valve Prosthesis; Heparin; Humans; Mitral Valve; Pregnancy; Pregnancy Complications, Cardiovascular; Warfarin

Prenatal exposure to oral anticoagulants during pregnancy may result in defective fetal development or life-threatening hemorrhage. Fetal exposure during the first eight weeks of pregnancy may cause abnormal development of the facial structures, hypoplastic digits, strippled epiphyses, and mental retardation. Midtrimester exposure may result in optic atrophy, faulty brain growth, and developmental retardation. Third-trimester exposure may produce fetal anticoagulation, predisposing the infant to life-threatening hemorrhage in the perinatal period. Anticoagulation with heparin sodium does not provide a clearly safe alternative, since this therapy has been associated with excessive fetal loss.

Topics: Abnormalities, Drug-Induced; Abnormalities, Multiple; Administration, Oral; Adult; Anticoagulants; Body Weight; Chondrodysplasia Punctata; Female; Fetus; Gestational Age; Humans; Infant, Newborn; Maternal-Fetal Exchange; Optic Atrophy; Pregnancy; Pregnancy Complications, Cardiovascular; Rheumatic Heart Disease; Vitamin K; Warfarin

Topics: Abnormalities, Drug-Induced; Abnormalities, Multiple; Humans; Infant; Male; Time Factors; Warfarin

Topics: Abnormalities, Drug-Induced; Abnormalities, Multiple; Female; Humans; Infant, Newborn; Pregnancy; Warfarin