Maintaining a patent ductus arteriosus with prostaglandins

Check your answers on page 10.12968/jprp.2023.5.8.350

The ductus arteriosus is a connection between the aorta and the pulmonary arteries, an integral part of appropriate foetal circulation. In most cases, it is not needed after a child is delivered and can cause problems, such as persistently high pulmonary blood pressures, heart failure and endocarditis, as proper adult circulation does not become fully established. However, there are certain cardiac malformations; for example, tetralogy of Fallot or transposition of the great arteries, which can benefit from the duct being kept open until a longer-term intervention can be made.

Placental prostaglandins are one of the factors that help keep the duct open, and the loss of the placenta during birth usually facilitates closure. In the absence of the placental prostaglandins, exogenous prostaglandin E2 (Pfizer, 1986) can instead be infused. This is an unlicensed indication and can involve complex manipulations as the stock solution is a higher concentration than the doses needed will require.