July 10th, 2020

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Rapid Resolution of Lisinopril Associated Fetal Oligohydramnios After Intravenous Furosemide: A Case Report
Authors:  Bobby Brar, M.D., Shelley Mueller, M.S., Katherine Hom, M.D., and David Jackson, M.D.
BACKGROUND: Angiotensin-converting-enzyme (ACE) inhibitors are an increasingly prescribed class of medications. In utero exposure to ACE inhibitors can be fetotoxic. We describe a case of second trimester lisinopril associated fetal oligohydramnios that responded to medication cessation and intravenous furosemide.

CASE: A 39-year-old pregnant woman, G2P0010, was noted to have oligohydramnios on an 18-week ultrasound. Prolonged lisinopril exposure was discovered. The patient had previously forgotten to disclose continued use of this medication from the pregestational period. Lisinopril was subsequently discontinued. The oligohydramnios persisted over the next 2 weeks. A trial of 40 mg intravenous furosemide was attempted. Rapid resolution of the oligohydramnios was noted. Ultimately, the patient had an otherwise uncomplicated term delivery.

CONCLUSION: ACE inhibitor associated oligohydramnios may be reversible. Intravenous furosemide can assist in resolution of persistent low amniotic fluid in this setting. Patients must be screened for ACE inhibitor use early in pregnancy and counseled on all available interventions if accidental exposure occurs.
Keywords:  ACE inhibitors, antihypertensive agents, angiotensin-converting enzyme inhibitors, cardiotonic agents, diuretics, fetal, furosemide, in utero, lisinopril, oligohydramnios, sodium potassium chloride symporter inhibitors
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