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Rupture of Fetal Ductus Arteriosus Aneurysm

Tongsong, Theera MD*; Chanprapaph, Pharuhas MD*; Sittiwangkul, Rekwan MD; Sirichotiyakul, Supatra MD*

doi: 10.1097/01.AOG.0000160486.37321.d1
Case Reports
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BACKGROUND: Ductus arteriosus aneurysm is a rare fetal disorder.

CASE: A 35-year-old primigravida had an uneventful antenatal course. Ultrasound examination at 30 weeks of gestation revealed hydramnios. The fetal ductus arteriosus became saccular and dilated with turbulent flow and diameter of 2.5 cm. It was located at the left upper thorax, just distal to the pulmonic valve and extended to the thoracic aorta. A ductus arteriosus aneurysm was diagnosed prenatally. Five days after diagnosis, preterm labor occurred, and dexamethasone and terbutaline were administered. Six hours after initiation of terbutaline, the fetal heart rate suddenly dropped to 90 beats per minute (bpm). A bedside ultrasound examination performed immediately showed profound bradycardia. The aneurysm became a heterogeneous hypoechoic mass with no pulsation, and the fetal heart rate suddenly disappeared.

CONCLUSION: Ductus arteriosus aneurysm can be diagnosed prenatally, and terbutaline or dexamethasone may be associated with a risk for rupture.

A prenatally detected fetal ductus arteriosus aneurysm ruptured after dexamethasone administration and tocolysis with terbutaline.

Departments of *Obstetrics and Gynecology and †Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

Received June 5, 2004. Received in revised form July 30, 2004. Accepted September 16, 2004.

Address reprint requests to: Theera Tongsong, MD, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; e-mail: ttongson@mail.med.cmu.ac.th.

© 2005 The American College of Obstetricians and Gynecologists