Reactions 1462, p27 - 27 Jul 2013

SMidazolam/morphine

Fetal bladder rupture and urinary ascites followingin utero exposure: case report

A female fetus developed bladder rupture and urinaryascites following in utero exposure to midazolam andmorphine.

The mother [age not stated] developed respiratory failuredue to an H1N1 influenza virus infection at 31 + 5 weeks’gestation, and was admitted to an ICU for ventilatory support.During her first day of ventilation, she was sedated with aninfusion of morphine 2.5–10 mg/hour. She developed severeagitation during ventilation, and received an infusion ofmidazolam 5–15 mg/hour for 8 days. She was discharged13 days after admission, at 33 + 3 weeks’ gestation. At34 weeks’ gestation, she presented with decreased fetalmovements, and fetal ultrasound revealed severe abdominalascites compressing the diaphragm.

The mother underwent a caesarean section at 34 + 6 weeks’gestation, with 300mL of ascitic fluid drained prior to delivery.A female neonate was born, weighing 2656g, and with Apgarscores of 6 and 9 after 1 and 5 minutes, respectively. The babywas immediately intubated and ventilated for respiratorydistress. Abdominal ultrasound revealed ascites and a defect inthe posterior bladder wall. Micturition cystourethrogramconfirmed bladder rupture, and ascitic fluid test results werecharacteristic of urinary origin. At 34 hours of age, her serumcreatinine and urea levels increased, and her serum sodiumlevels decreased. She was oliguric, with a urine output of0.4 mL/kg/hour, and a urinary catheter was inserted. Herelectrolytes subsequently normalised, and her outputimproved. One month later, follow-up micturitioncystourethrogram showed closure of the defect, and thecatheter was removed.

Author comment: "Both morphine and midazolam canreadily cross the placenta. We postulate that in utero ourpatient developed urinary retention resulting in spontaneousbladder rupture following administration of morphine andmidazolam to the mother."Chaudhari T, et al. Maternal ventilation and sedation for H1N1 influenza resultingin fetal bladder rupture and urinary ascites. Journal of Paediatrics and Child Health49: E97-100, No. 1, Jan 2013. Available from: URL: http://dx.doi.org/10.1111/j.1440-1754.2012.02502.x - Australia 803090526

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Reactions 27 Jul 2013 No. 14620114-9954/13/1462-0001/$14.95 Adis © 2013 Springer International Publishing AG. All rights reserved