Background: Â Several congenital malformations such as craniofacial and digitalÂ abnormalities, and less commonly, cleft lip and palate have been reported withÂ phenobarbital. According to our knowledge, it is the first report of cloacal anomalyÂ and cleft palate following prenatal phenobarbital exposure.
Case: A 20-year-old gravid 1, Para 1 woman at 40 weeks of gestation was admittedÂ for a normal vaginal delivery. She had a history of convulsion one month beforeÂ pregnancy. The described dosage of Phenobarbital by her physician was 100mgÂ every night but she had increased the dosage to 100mg q8h incidentally. OtherÂ medication was folic acid in usual dosage and continued until delivery. There wasÂ no familial history of birth defects, any antenatal infection or exposure to any otherÂ medications, alcohol, smoking, or exposure to X-rays. Pregnancy was uncomplicatedÂ and a baby girl weighing 2600g was born. APGAR scores were 8 and 9 at 1 andÂ 5 minutes, respectively. By clinical picture, diagnosis of cloacal anomaly wasÂ confirmed. The other anomalies were cleft palate, a small patent ductus arteriosusÂ in echocardiography and a short sacrum. A nuclear renal scan, which was performedafter two months, suggested severe decrease perfusion and function of right kidney.Â The patient was treated with multiple operations on oral, urogenital and anorectalÂ system.Â
Conclusion: In addition to previously recognized risks associated withÂ phenobarbital during pregnancy, cloacal anomaly should be considered as a possibleÂ adverse outcome.
Seyed Abdollah Mousavi , Ebrahim Salehifar
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