The presentation of the fetal warfarin syndrome depends on the quantity of the drug that the mother has ingested, the teratogenicity being dose dependent [1] and the duration of the fetal exposure to warfarin. The greatest risk is encountered during the sixth and the ninth week of gestation [2] [3]. The drug has a low molecular weight and crosses the placenta, causing vitamin K deficiency in the embryo or fetus. The mother can present for spontaneous abortion or the pregnancy can be carried to term, but the child may be born dead or die during the neonatal period [4]. When the child survives, he or she has a series of congenital abnormalities [5] [6]. The facial traits of a fetal warfarin syndrome-affected child include nasal hypoplasia, nose bridge depression, the presence of a groove between the tip of the nose and the alae nasi. Small nostrils resulting from these abnormalities may impair air flow and cause neonatal respiratory distress, that may be severe enough to require intervention. Osseous stippling occurs in the axial skeleton and femurs [7]. It may be accompanied by scoliosis and hypoplasia of the extremities, ranging from rhizomelia to dystrophic nails. Central nervous system and eye malformations occur more frequently when the fetus has been exposed to warfarin during the second and third trimesters of pregnancy. Abnormalities consist of hydrocephalus, microcephaly, corpus callosum agenesis, microphthalmia and optic atrophy. Blindness, deafness, and seizures, as well as severe bleeding at birth, not predictable from the maternal international normalized ratio, may also be seen [8] [9]. Other teratogenic effects of warfarin include cardiac and laryngeal abnormalities, aortic coarctation, situs inversus totalis, ventral midline dysplasia, bilobed lungs, congenital cataract, short neck, cleft palate and/or lip [10], mental retardation, feeding difficulties, widely spaced nipples and the Dandy-Walker malformation. Hypotonia or muscular spasticity may be encountered. These children usually fail to thrive.

• Coarctation of the Aorta

  Congenital heart defects such as a thinned atrial septum, coarctation of the aorta, patent ductus arteriosus; a connection between the pulmonary artery and aorta occur in 8% of fetal warfarin syndrome patients. [en.wikipedia.org]

• Multiple Congenital Anomalies

  G. (1977) Multiple congenital anomalies associated with oral anticoagulants. American Journal of Obstetrics and Gynecology, 127: 191–198. Spranger, J. W., Opitz, J. M. and Bidder, U. (1971) Heterogeneity of chondrodysplasia punctata. [cambridge.org]

• Hypoventilation

  Results of a multinational study showed that the prevalence of obesity hypoventilation syndrome among patients with obstructive sleep apnea (osa) rises as bmi increases, dr. When using the past taro warfarin 50 years. [refopasex.atspace.us]

• Failure to Thrive

  […] to thrive Numerology Chaldean Numerology The numerical value of fetal warfarin syndrome in Chaldean Numerology is: 6 Pythagorean Numerology The numerical value of fetal warfarin syndrome in Pythagorean Numerology is: 4 Images & Illustrations of fetal [definitions.net]

  […] to thrive Causes - Fetal warfarin syndrome Not supplied. [checkorphan.org]

  Symptoms and Signs Symptoms include low birth weight, seizures, reduced muscle tone, deafness, feeding difficulty, shortened fingers, widely spaced nipples, and failure to thrive. Warfarin ingestion may also be chronic or acute. [dianamossop.com]

  Symptoms & Signs Symptoms include low birth weight, seizures, reduced muscle tone, deafness, feeding difficulty, shortened fingers, widely spaced nipples & failure to thrive. Warfarin ingestion may also be chronic or acute. [signssymptoms.org]

  Additionally, warfarin can cause birth defects such as abnormal development of the spine, changes to bones in the face (especially the nose), intellectual disability, and failure to thrive. [diseaseinfosearch.org]

• Acrocyanosis

  After admission to NICU, baby had mild respiratory distress with mild acrocyanosis and intercostal recessions HR: 145/min, RR: 70/min, PP: well felt, BP: 66/40 mmHg, SpO2: 90 % at room air. [jemds.com]

• Systolic Murmur

  (Fig: 7, 8, 9) In systemic examination, CVS examination showed a systolic murmur of grade 3/6 with all other systems within normal limits. [jemds.com]

• High Arched Palate

  Head to toe examination it was observed that the baby has depressed nasal bridge, a high arched palate, short neck. Detailed laboratory evaluation was done. Ultrasound of brain and abdomen were normal. [jemds.com]

• Mouth Breathing

  Speech and language assessment revealed high palate, mouth breathing, little nasal patency, and shortened upper lip. [ncbi.nlm.nih.gov]

• Hearing Impairment

  Less often, affected individuals exhibit hearing impairment, incomplete closure of the roof of the mouth (cleft palate), misalignment of the eyes (strabismus), structural malformations of the heart (congenital heart defects), mild intellectual disability [rarediseases.org]

• Widely Spaced Nipples

  spaced nipples and the Dandy-Walker malformation. [symptoma.com]

  spaced nipples, Deafness, Feeding difficulty, Failure to thrive Numerology Chaldean Numerology The numerical value of fetal warfarin syndrome in Chaldean Numerology is: 6 Pythagorean Numerology The numerical value of fetal warfarin syndrome in Pythagorean [definitions.net]

  spaced nipples * Deafness * Feeding difficulty * Failure to thrive Causes - Fetal warfarin syndrome Not supplied. [checkorphan.org]

  Symptoms and Signs Symptoms include low birth weight, seizures, reduced muscle tone, deafness, feeding difficulty, shortened fingers, widely spaced nipples, and failure to thrive. Warfarin ingestion may also be chronic or acute. [dianamossop.com]

  Symptoms & Signs Symptoms include low birth weight, seizures, reduced muscle tone, deafness, feeding difficulty, shortened fingers, widely spaced nipples & failure to thrive. Warfarin ingestion may also be chronic or acute. [signssymptoms.org]

• Pelvic Pain

  Brand new chapters provide up-to-date, comprehensive coverage of topics relevant to current practice: -First Trimester Fetal Anatomy -Obstetric Ultrasound and the Obese Patient -Evaluation of Pelvic Pain in the Reproductive Age Patient -Gynecologic Ultrasound [books.google.de]

• Grunting

  Baby had mild respiratory distress with intercostal recessions and acrocyanosis but no grunting. Thus in view of prematurity, bad obstetric history, mild respiratory distress and being a precious baby, the baby was shifted to NICU. [jemds.com]

• Poor Coordination

  This syndrome requires immediate medical attention and may include one or more of the following symptonxiety, restlessness, loss of consciousness, confusion, weakness, tremor, poor coordination, fever, shivering, sweating, vomiting, a fast heartbeat, [refopasex.atspace.us]

Fetal warfarin syndrome diagnosis is mostly based on pregnancy history and clinical examination. However, skeleton radiographs can provide additional information, such as the epiphyseal stippling of vertebrae, long bones, and sacrum. These findings are transient and disappear as the child grows older [11]. Scoliosis, as well as short limbs and digits, can also be noticed on radiological films [12]. Epiphyses can be found to be non calcified. These findings are present in 5-12% of infants who were exposed to warfarin between the sixth and the ninth week of gestation.

• Ovarian Mass

  Features new practice guidelines for obstetric evaluation (including first trimester assessment) and gynecologic management (including evaluation of the endometrium and of ovarian masses). [books.google.de]

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2. Van Driel D, Wesseling J, Rosendaal FR, et al. Growth until puberty after in utero exposure to coumarins. Am J Med Genet. 2000;95:438-43.
3. Walfisch A, Koren G. The ‘warfarin window’ in pregnancy: the importance of half-life. JOGC. 2010;32:988–9.
4. Hall JG, Pauli RM, Wilson K. Maternal and fetal sequelae of anticoagulant during pregnancy. Am J Med 1980;68:122-40.
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7. Menger H, Lin AE, Toriello HV, et al. Vitamin K deficiency embryopathy: a phenocopy of the warfarin embryopathy due to a disorder of embryonic vitamin K metabolism. Am J Med Genet. 1997;72:129-34.
8. Lee HC, Cho SY, Lee HJ, et al. Warfarin-associated fetal intracranial hemorrhage: A case report. J Korean Med Sci. 2003;18:764-7.
9. Masamoto H, Uehara H, Mekaru K, et al. Warfarin-associated fetal intracranial hemorrhage in woman with mitral valve replacements: a case report. Am J Perinatol. 2009;26:597–600.
10. Chan WS, Anand S, Ginsberg JS. Anticoagulation of pregnant women with mechanical heart valves: a systematic review of the literature. Arch Intern Med. 2000;160:191–6.
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12. Sathienkijkanchai A, Wasant P. Fetal Warfarin syndrome. J Med Assoc Thai. 2005;88(Suppl 8):S246–50.