Indomethacin dosing and constriction of the ductus arteriosus during open fetal surgery for myelomeningocele repair

Lisa W. Howley, Debnath Chatterjee, Sonali S. Patel, Bettina F. Cuneo, Timothy M. Crombleholme, Nicholas Behrendt, Michael V Zaretsky, Ahmed I. Marwan, Jeannie Zuk, Henry L. Galan, Cristina Wood

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Introduction: The use of perioperative tocolytic agents in fetal surgery is imperative to prevent preterm labor. Indomethacin, a well-known tocolytic agent, can cause ductus arteriosus (DA) constriction. We sought to determine whether a relationship exists between preoperative indomethacin dosing and fetal DA constriction. Materials and Methods: This is an IRB-approved, single-center retrospective observational case series of 42 pregnant mothers who underwent open fetal myelomeningocele repair. Preoperatively, mothers received either 1 (QD) or 2 (BID) indomethacin doses. Maternal anesthetic drug exposures and fetal cardiac dysfunction measures were collected from surgical and anesthesia records and intraoperative fetal echocardiography. Pulsatility Index was used to calculate DA constriction severity. Comparative testing between groups was performed using t- A nd chi-square testing. Results: DA constriction was observed in all fetuses receiving BID indomethacin and in 71.4% of those receiving QD dosing (p = 0.0002). Severe DA constriction was observed only in the BID group (35.7%). QD indomethacin group received more intraoperative magnesium sulfate (p < 0.0001). Minimal fetal cardiac dysfunction (9.5%) and bradycardia (9.5%) were observed in all groups independent of indomethacin dosing. Conclusions: DA constriction was the most frequent and severe in the BID indomethacin group. QD indomethacin and greater magnesium sulfate dosing was associated with reduced DA constriction.

Original languageEnglish (US)
Pages (from-to)339-344
Number of pages6
JournalFetal Diagnosis and Therapy
Issue number5
StatePublished - May 1 2019
Externally publishedYes


  • Bradycardia
  • Cardiac dysfunction
  • Doppler
  • Ductus arteriosus
  • Fetal surgery
  • Indomethacin
  • Magnesium sulfate
  • Myelomeningocele

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Embryology
  • Radiology Nuclear Medicine and imaging
  • Obstetrics and Gynecology


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