Cases reported • Abnormalities, Drug-Induced

11/15. Crossed renal ectopia associated with maternal alkaloid cocaine abuse: a case report.

Although cocaine abuse has declined in popularity in the united states, certain groups continue to use the drug at high rates. The teratogenicity of cocaine has been widely investigated in the newborn. We report a case of crossed renal ectopia in a term neonate whose mother practiced alkaloid cocaine abuse in the first trimester of pregnancy. We propose that this anomaly was caused by cocaine's direct pharmacologic effect, leading to vasoconstriction that affected the developing fetal kidney by compromising the blood vessels that supply the organ or by causing hemorrhages and infarctions with fibrosis, causing disruption during a crucial period of morphogenesis.

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12/15. holoprosencephaly and trisomy 13 in a fetus with maternal early gestational amphetamine abuse--a case report.

We report a congenital anomalous fetus with holoprosencephaly, prenatally diagnosed by sonography and MR scan at the twenty-sixth week during the gestational period. Chromosome analysis by amniocentesis revealed trisomy 13 (47,XY,+13). The diagnosis was confirmed by autopsy. After induction, external examination showed a proboscis-like nose on the normal nose position. The right foot showed polydactylia with wide separation of the fifth and sixth toes. We found that the mother was an abuser of amphetamine at an early gestational age. The teratogenic effect of D-amphetamine on animals has been noted, but no previous clinical case of a congenital anomalous fetus and maternal abuse of amphetamine has been reported. This case report is the first to reveal holoprosencephaly and trisomy 13, with maternal early gestational abuse of amphetamine.

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13/15. First trimester disulfiram exposure: report of two cases.

disulfiram has been used effectively to deter alcohol consumption in patients with a history of alcohol abuse. Its use in reproductive age women has become increasingly common in recent years, intensifying the risk of fetal exposure. Nonspecific but significant abnormalities have been described in the infants of women treated with disulfiram in the first trimester of their pregnancies. Based on these data, authors have previously exposure is confirmed despite a lack of any pattern to the defects reported. We report the outcomes of two pregnancies with first trimester disulfiram exposure. In both cases, the timing and dose of disulfiram was known. In one case, disulfiram was the only potential teratogen exposed to the fetus. Both neonates were normal at birth and have shown subsequent normal development. This report suggests that the poor prognosis previously given to fetuses exposed to disulfiram in the first trimester may not be warranted.

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14/15. Case study of the home health management of a child with congenital anomalies associated with prenatal cocaine abuse.

The presence of a history of poor parental upbringing, poverty, and substance abuse within a family stresses its capacity to cope with the needs of a child with congenital anomalies. nursing has a key role to play in providing specific information, practical assistance, and support in these circumstances. A case study of a child in such a family is presented in this article, and the multiple nursing interventions provided to facilitate the family's coping skills are discussed.

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15/15. Prenatal exposure to disulfiram implicated in the cause of malformations in discordant monozygotic twins.

Female monozygotic (MZ) twins were discordant for congenital structural anomalies: Twin A had a reduction defect of the right forearm; Twin B had a cleft palate. Both infants were small for gestational age. Specific prenatal exposures were identified at different times in the first trimester of pregnancy: crack cocaine, marijuana, disulfiram, heavy ethanol exposure, and cigarettes. The mother's hospitalization in a drug abuse program and incarceration allowed for identification of exposure timing. The cleft palate could have been related to either disulfiram or alcohol exposure; the limb abnormality most likely corresponded to the timing of disulfiram exposure. Discordance of anomalies in these twins may reflect differences in developmental timing, differences in susceptibility to one or more teratogens, or random events occurring within very complex developmental programs, with the thresholds for malformation affected by one or multiple teratogenic compounds.

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