Foetal warfarin syndrome - A case report

Abstract

A term infant with features of warfarin embryopathy is described. His mother had mitral valve replacement for rheumatic heart disease and conceived while taking warfarin for thromboprophylaxis. A cardiologist and an obstetrician first saw her at 12 weeks gestation. She took warfarin until 36 weeks gestation. Antenatal diagnosis of embryopathy was suspected at 24 weeks gestation when an ultrasound scan revealed a flat lateral profile of the foetal face. At birth, the baby was found to have midface hypoplasia with a flat nasal bridge, associated with a prominent groove between the nasal tip and alar nasi. Choanal stenosis caused upper airway obstruction. Skeletal survey showed stippling of the vertebral bodies, tarsal bones and some phalanges. Mechanisms in the pathogenesis of the syndrome are explored and various strategies for anticoagulation discussed.