Neonatal limb ischemia following maternal indomethacin treatment in twin pregnancies.

The prenatal administration of indomethacin in obstetric management has been implicated as a cause of neonatal cardio-pulmonary, gastrointestinal and renal complications. The present report describes two cases of twin pregnancy resulting in premature delivery at the 33rd and 30th week following prolonged maternal indomethacin treatment for 9 and 4 weeks respectively. Neonatal cardiovascular and renal complications were observed and an unusual severe ischemia of a lower limb occured in each of the first twins following insertion of an umbilical arterial line. It is suggested that prolonged antenatal exposure to the drug may increase the systemic arterial constrictive reactivity in some newborn infants and that special caution should be exercised during arterial catheterization of susceptible cases.