The question concerns a 29-year-old pregnant woman with fetal age eight weeks and six days accordin

Fråga: The question concerns a 29-year-old pregnant woman with fetal age eight weeks and six days according to ultrasound. Her last period was 6th of December. The patient visited Africa 28th of December to 5th of January. She was given yellow fever vaccine the 27th of December and took malaria prophylaxis in the form of chloroquine and Paludrine (proguanil). Pregnancy tests were negative 14th and 24th of January. She was operated upon 27th of January and was in this connection treated with morphine, Voltaren (diclofenak), Diprivan (propophol) and Forene (isoflurane). The patient is now worried about the risk for fetal damage.

Sammanfattning: None of the drugs involved has been shown to be teratogenic but for several of them the experience in pregnant women is too scarce to state that their use during pregnancy is safe. There is thus no indication for terminating the pregnancy. Due to the limited information on propofol and isoflurane there is a need for follow-up of the patient and to report the result of the pregnancy irrespective of its outcome.

Svar: All of the drugs mentioned above have previously been investigated and documented in Drugline (1,2,3,4,5). According to FASS (6) isoflurane is category B1 and proguanil is category A thus with low risks of fetal damage. For the detailed evaluation of the other compounds the answers to previous questions are referred to. To summarize these questions it can be stated that for none of the drugs involved is there a positive evidence that they are teratogenic and there is thus no indication for abortion. However, neither is there sufficient evidence to exclude the possibility that there actually is an increased risk for adverse effects on the fetus. The patient should therefore be followed more closely. For one of the drugs, propofol, the experience in pregnant women is very limited and a follow-up is therefore warranted.<div id="referenser" style="display:none;">1 Drugline nr 04872 (year 1985)<br>2 Drugline nr 04988 (year 1986)<br>3 Drugline nr 09304 (year 1992)<br>4 Drugline nr 09412 (year 1992)<br>5 Drugline nr 09906 (year 1993)<br>6 FASS 1994</div>