Translational Biomedicine

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Cloacal anomaly and cleft palate following Phenobarbital usage during pregnancy: the first report

Seyed Abdollah Mousavi , Ebrahim Salehifar

Background:  Several congenital malformations such as craniofacial and digital abnormalities, and less commonly, cleft lip and palate have been reported with phenobarbital. According to our knowledge, it is the first report of cloacal anomaly and cleft palate following prenatal phenobarbital exposure.

Case: A 20-year-old gravid 1, Para 1 woman at 40 weeks of gestation was admitted for a normal vaginal delivery. She had a history of convulsion one month before pregnancy. The described dosage of Phenobarbital by her physician was 100mg every night but she had increased the dosage to 100mg q8h incidentally. Other medication was folic acid in usual dosage and continued until delivery. There was no familial history of birth defects, any antenatal infection or exposure to any other medications, alcohol, smoking, or exposure to X-rays. Pregnancy was uncomplicated and a baby girl weighing 2600g was born. APGAR scores were 8 and 9 at 1 and 5 minutes, respectively. By clinical picture, diagnosis of cloacal anomaly was confirmed. The other anomalies were cleft palate, a small patent ductus arteriosus in echocardiography and a short sacrum. A nuclear renal scan, which was performedafter two months, suggested severe decrease perfusion and function of right kidney. The patient was treated with multiple operations on oral, urogenital and anorectal system. 

Conclusion: In addition to previously recognized risks associated with phenobarbital during pregnancy, cloacal anomaly should be considered as a possible adverse outcome.