Antenatal Closure of the Ductus Arteriosus and Hydrops Fetalis

Abstract

Antenatal closure of the ductus arteriosus has been speculated, but rarely reported, as a cause of hydrops fetalis. The purpose of this prospective autopsy study was to find the incidence of antenatal closure of the ductus arteriosus and hydrops fetalis in a high-risk obstetric population and to find associated factors that might give clues to the cause of antenatal closure of the ductus arteriosus. Antenatal closure of the ductus arteriosus had to be stringently sought by in situ examination. Fifteen stillborns with antenatal closure of the ductus arteriosus were found in 684 perinatal autopsies (2.2%), including 511 stillborns (2.9%). All 15 stillborns with antenatal closure of the ductus arteriosus also had hydrops fetalis and accounted for 35% of the 43 stillborns with hydrops fetalis. Antenatal closure of the ductus arteriosus in these 15 stillborns was not associated with maternal aspirin use but was associated with a myriad of factors, including intrauterine infection (60%), umbilical cord abnormalities (67%), and retroplacental hemorrhage (87%), that can cause hypoxic-ischemic stress.