Hydrocephalus and abnormal digits after failed first-trimester prostaglandin abortion attempt

Abstract

The possible teratogenic effects of prostaglandins (PGs) in humans have not been investigated in detail, yet these drugs appear to be deleterious in laboratory animals. A case report is presented of congenital anomalies in a newborn infant whose mother received intravaginal PG 7 weeks after conception but failed to abort. The infant was delivered after 34 weeks' gestation with a birth weight of 2.34 kg. The mother had been placed in an experimental protocol using intravaginal PG 15-methyl F2alpha. She received 1 mg, then another 3 mg after 1 hour and was sent home with instructions to call in 24 hours if no tissue was passed. She experienced nausea, vomiting, and intense abdominal cramping but no vaginal blood or tissue loss occurred. She then decided to continue the pregnancy and did not mention these events when she went to a different clinic for prenatal care. Routine ultrasound examination at 24 weeks disclosed dilated lateral cerebral ventricles, which progressively enlarged over the next 3 weeks. No other anomalies were seen. Amniotic fluid alpha-fetoprotein concentration was normal, and karotype was 46,XY. Referral was made to Yale-New Haven Hospital, where at 27 weeks a silastic catheter was placed by Dr. Richard Berkowitz through the fetal skull into the left lateral ventricle under ultrasound guidance, creating a ventriculoamniotic shunt. There was an initial decrease in the size of the left lateral ventricle and improvement in thickness of the corticle mantle. The right ventricle remained enlarged, and the left dilated again after 4-6 weeks, indicating probable blockage of the shunt. The infant was delivered at 34 weeks by cesarean section after pulmonary maturity was demonstrated by amniotic fluid L/S ratio. At birth the Apgar score was 9 at 5 minutes and maturity ratings were consistent with 34-35 weeks. The head was large, the circumference being 34 1/2 cm. The face was not dysmorphic but the ears appeared slightly small. The most striking abnormality concerned the digits of all 4 limbs; all were tapered and shortened with hypoplastic or absent nails. There was a left simian crease. The infant had a shrill cry and was hypertonic but a good suck was present. Radiographs of the hands revealed missing or hypoplastic distal phalanges of all fingers; the middle phalanges of the 3rd and 4th digits of the right hand also were absent. More proximal osseous structures were normal. A search of the literature failed to reveal a report of the association of hydrocephalus and these digital anomalies.