Early Human Development, 1978, 2/l, 15-23 o Elsevier/North - Holland Biomedical Press
Premature closure of the ductus arteriosus (P.C.D.A.): intrauterine circulatory failure
15
a possible cause of
H.G. KOHLER The Maternity
Hospital at Leeds, Leeds, United Kingdom
Accepted for publication 27 September 1977
SUMMARY
In the course of some 800 perinatal necropsies (corresponding to approximately 26,000 deliveries), 3 stillborn infants were found to have an almost completely closed ductus arteriosus. Each of these showed cardiomegaly, dilatation of right-sided chambers, pulmonary hyperaemia and oedema of varying degree and extent; intrauterine death was considered to be due to P.C.D.A. In several further cases the.ductus was also narrowed but not necessarily responsible for intrauterine death. This frequency suggests that P.C.D.A. is more common than might be surmised from very scanty documentation in the literature. Possible aetiological factors of P.C.D.A. as well as its effects on the circulation are briefly discussed.
INTRODUCTION
“Persistance of the ductus arteriosus is one of the commonest isolated congenital malformations affecting the heart” [l] . The literature on this anomaly is extensive. In contrast, premature closure of the ductus arteriosus (P.C.D.A.) has been observed very rarely, and case reports are so few that they can be reviewed wit& the framework of a brief article. The question whether the ductus arteriosus can ever close before, during, or immediately after birth was first ventilated in October 1846 before the Ayr (Scotland) Circuit Court of Justiciary [2], trying a case of alleged infanticide. The identity of a dead infant had to be proven. The medico-legal experts held that the body found on the beach could not be that of the accused woman’s child, because it was known from circumstantial evidence
16
that her child had been disposed of within 30 min of delivery: at autopsy, the ductus arteriosus had been closed, so it was concluded that this infant must have lived substantially longer than 30 min and could not be the accused woman’s child. The jury, however, accepted the identity of the infant .-.- and were probably right in so doing. They passed, however, a verdict of “not proven” on the infanticide charge. This case was widely reported and the Monthly Journal of Medical Science had two editorial comments on it (Nov. 1846 and Jan. 1847). Even today, we are bound to agree with the conclusion that “the case altogether suggests the necessity of new enquiries on the several points . . . . . and of the several states in which the ductus arteriosus may be found when death has taken place immediately after birth”. Only a few months later, another case was presented by Chevers [3] : The infant was born at “seven months-and-a-half”, and died at the age of 15 min ‘
Premature closure of the ductus arteriosus (P.C.D.A.): intrauterine circulatory failure
15
a possible cause of
H.G. KOHLER The Maternity
Hospital at Leeds, Leeds, United Kingdom
Accepted for publication 27 September 1977
SUMMARY
In the course of some 800 perinatal necropsies (corresponding to approximately 26,000 deliveries), 3 stillborn infants were found to have an almost completely closed ductus arteriosus. Each of these showed cardiomegaly, dilatation of right-sided chambers, pulmonary hyperaemia and oedema of varying degree and extent; intrauterine death was considered to be due to P.C.D.A. In several further cases the.ductus was also narrowed but not necessarily responsible for intrauterine death. This frequency suggests that P.C.D.A. is more common than might be surmised from very scanty documentation in the literature. Possible aetiological factors of P.C.D.A. as well as its effects on the circulation are briefly discussed.
INTRODUCTION
“Persistance of the ductus arteriosus is one of the commonest isolated congenital malformations affecting the heart” [l] . The literature on this anomaly is extensive. In contrast, premature closure of the ductus arteriosus (P.C.D.A.) has been observed very rarely, and case reports are so few that they can be reviewed wit& the framework of a brief article. The question whether the ductus arteriosus can ever close before, during, or immediately after birth was first ventilated in October 1846 before the Ayr (Scotland) Circuit Court of Justiciary [2], trying a case of alleged infanticide. The identity of a dead infant had to be proven. The medico-legal experts held that the body found on the beach could not be that of the accused woman’s child, because it was known from circumstantial evidence
16
that her child had been disposed of within 30 min of delivery: at autopsy, the ductus arteriosus had been closed, so it was concluded that this infant must have lived substantially longer than 30 min and could not be the accused woman’s child. The jury, however, accepted the identity of the infant .-.- and were probably right in so doing. They passed, however, a verdict of “not proven” on the infanticide charge. This case was widely reported and the Monthly Journal of Medical Science had two editorial comments on it (Nov. 1846 and Jan. 1847). Even today, we are bound to agree with the conclusion that “the case altogether suggests the necessity of new enquiries on the several points . . . . . and of the several states in which the ductus arteriosus may be found when death has taken place immediately after birth”. Only a few months later, another case was presented by Chevers [3] : The infant was born at “seven months-and-a-half”, and died at the age of 15 min ‘
![[Premature constriction of the ductus arteriosus].](/assets/img/hold.png)
