SDMS CME Credit – A Case Series: Is the Use of Acetaminophen Still Safe in Pregnancy?

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Authors: Carol Boctor, MA, HangYu Watson, MD, Nita Ray Chaudhuri, MD, Mehar Hoda, MD, and Salwa Gendi, MD

Category: Fetal Echocardiography [FE]

Credit: 0.75 SDMS CME Credit

Objectives: After studying the article, you should be able to:

• Describe the physiological role of the ductus arteriosus (DA) in fetal circulation and the mechanisms involved in its patency and closure.

• Explain the potential association between maternal acetaminophen use during pregnancy and premature DA constriction in the fetus.

• Identify sonographic findings used to assess fetal DA constriction.

1. Which mechanism is proposed to explain how acetaminophen may contribute to ductus arteriosus (DA) constriction in the fetus?

2. B. Enhancing pulmonary blood flow

3. C. Inhibiting prostaglandin synthesis

4. D. Stimulating fetal cortisol release

According to the article, what might contribute to the underestimation of DA constriction associated with acetaminophen use in clinical settings?

A. Acetaminophen is metabolized rapidly in the fetus

B. Routine fetal echocardiography is rarely performed

C. Constriction is always permanent and easy to detect

D. NSAIDs are more commonly used in pregnancy

In a normal fetal echocardiogram, what is the expected peak systolic velocity of the DA?

A. Up to 1.4 m/s

B. Less than 0.5 m/s

C. Greater than 2.0 m/s

D. Between 2.5–3.0 m/s

What sonographic finding is consistent with DA constriction?

A. Decreased systolic and diastolic velocities

B. Elevated systolic and diastolic velocities

C. Absent DA waveform on Doppler

D. Reversed flow in the umbilical artery

In the case series, what was a common management step following the identification of DA constriction in the fetus?

A. Immediate surgical intervention

B. Discontinuation of acetaminophen

C. Initiation of beta blockers

D. Administration of diuretics

In addition to acetaminophen, which maternal factor was identified in Patient Case 4 as a potential contributor to DA constriction?

A. Low-protein diet

B. Recreational marijuana use

C. Iron supplementation

D. Daily caffeine intake

Which imaging view is most commonly used to obtain Doppler velocities of the DA in fetal echocardiography?

A. Four-chamber view

B. Apical long axis view

C. Sagittal ductal arch view

D. Subcostal transverse view