Iatrogenic Adverse Fetal Events - A Clinical Sequelae of Nimesulide use in Third Trimester of Pregnancy. Review of Literature along with Case Report

Objective To describe clinical consequences after maternal intake of nimesulide, a nonsteroidal anti-inflammatory (NSAIDS) drug which is selective cyclo-oxygenase (COX) type-2 inhibitor. Methods Case Report Results Reviewing clinical history of a mother who presented with ultrasonographic scan showing oligohydromnios (AFI ~ 3- 4) at 34 weeks 2 days of gestation, history revealed intake of tablet nimesulide for lower backache. On evaluation, fetal echocardiogram showed restrictive flow pattern in ductus arteriosus. Fetal surveillance by Non stress test showed abnormal fetal heart rate recording with baseline fetal tachycardia (~ 180 beats per minute) at 35weeks 2 days of gestation and biophysical profile was poor (=2) which nesseciated urgent abdominal delivery. Neonatal echocardiogram on third day of life was normal. Conclusion Adverse fetal events observed in this case like oligohydromnios, premature ductal constriction with restrictive flow pattern, abnormalities in fetal heart rate trace denotes clinical sequelae of maternal nimesulide use, which were avoidable by spreading awareness regarding use of analgesic drugs in pregnancy.