Dipyrone-induced oligohydramnios and ductus arteriosus restriction.

722 Dipyrone (Optalgin®) is a non-steroidal anti-inflammatory drug that inhibits cyclooxygenase-1 and cyclooxygenase-2 activity, thereby reducing the production of prostaglandin E2 and E1. This effect is not unique to pregnant women or fetuses but occurs widely in adults, particularly in patients with contracted intravascular fluid volume as a result of congestive heart failure, cirrhosis, diuretic use, or restricted sodium intake. All these clinical situations are at increased risk for NSAID-related changes in renal function. The drug is widely used in many countries as an an-algetic and antipyretic agent, especially in some parts of Europe, South America and Asia. It was banned in the United States by the Food and Drug Administration in 1977 because of a possible association with agranulocytosis. In contrast to other NSAIDs, precautions regarding the use of dipyrone during pregnancy are not well defined and information on its safety in pregnancy is scarce. A weak association with Wilms' tumor was found in children of women who took dipyrone during pregnancy [1]. Other suggested adverse effects are leukemia and neural tube defects found in mice. The association of NSAIDs with oligohydramnios was described in a series of patients who took indometha-cin [2], and in only two case reports of dipyrone use. We report another case of dipyrone-associated oligohydramnios with fetal ductus arteriosus restriction. A 26 year old woman in the 35th week of her first pregnancy was admitted with an Escherichia coli urinary tract infection. Her past medical history was uneventful. Her pregnancy was also uneventful, except NSAID = non-steroidal anti-inflammatory drug for a positive triple test. All sonographic studies during pregnancy were normal, including amniotic fluid evaluated 8 days before admission to the hospital. Three days before her index admission she took dipyrone (Optalgin®, V-Talgin®, Phanalgin®), 6 g a day for 3 days, and papaverine HCL to relieve her urinary symptoms. Her physical examination was normal except for left flank tenderness. She was normotensive. Her kidney function tests were within normal values for pregnant women; urea 3.0 mmol/L (normal non-pregnant values 3.3–6.5 mmol/L), cre-atinine 44 μmol/L (normal non-pregnant 60–106 μmol/L), uric acid 184 μmol/L (normal 150–380 μmol/L). Complete blood count was normal as were blood electrolytes. Obstetric ultrasound examination revealed oligohydramnios with an amniotic fluid index of 40 mm (normal 50–240 mm) and restricted ductus arteriosus. Analgesic treatment was replaced with paracetamol, and antibiotic treatment with intravenous cefuroxime was initiated. Serial fetal sonographic examinations showed an improvement …