Fetal exposure to maternal oral anticoagulants during the third trimester can result in a number of serious hemorrhagic complications.
NOTE: Exposure during the first trimester can result in warfarin embryopathy, which is discussed in Chapter 44.
Hemorrhagic complications:
(1) cutaneous or subcutaneous, which may be extensive
(2) intracerebral, primarily intraventricular
(3) intraocular
(4) gastrointestinal
(5) pericardial or pleural
(6) placental
If the hemorrhage occurs as an antenatal events, then the fetus may experience:
(1) fetal distress
(2) prematurity
(3) stillbirth
If the hemorrhage occurs as a perinatal event, then the infant may show:
(1) hydrocephalus
(2) mental retardation
(3) ocular complications
A fetus exposed to maternal oral anticoagulants should be delivered by Cesarean section, since contractions during vaginal delivery can result in subcutaneous or intracerebral hemorrhage.
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