What is a potential fetal risk associated with Indocin?

Indocin, or indomethacin, is a nonsteroidal anti-inflammatory drug (NSAID) that can be used to inhibit preterm labor. However, its use during pregnancy, specifically in the latter trimesters, has been associated with certain risks to the fetus. One significant potential risk is the development of pulmonary hypertension, particularly persistent pulmonary hypertension of the newborn (PPHN).

Indomethacin can cause changes in the fetal circulation, particularly through its inhibition of prostaglandin synthesis. Prostaglandins are crucial for maintaining the patency of the ductus arteriosus, a vessel that connects the pulmonary artery to the aorta in the fetus. If Indocin is used, it may prematurely close the ductus arteriosus, leading to increased pulmonary vascular resistance and resulting in pulmonary hypertension at birth. This complication can manifest as difficulty breathing, cyanosis, and other signs of respiratory distress shortly after delivery.

Understanding this risk emphasizes the need for careful consideration when using Indocin in pregnant patients, especially in those who may be approaching term or have pre-existing conditions that could exacerbate pulmonary issues in the neonate. Each potential fetal risk should be meticulously evaluated against the benefits of using Indocin in obstetric management.