Ultrasound diagnosis of multiple anomalies associated with prenatal oral contraceptives

The case of a 22-year old woman with 1 child who became pregnant soon after initiating use of Ortho-Novum 1 + 50 pills is described. The patient had smoked 20-30 cigarettes/day for 2 years. There was no history of exposure to other potential teratogens or of maternal illnesses, and the family history was noncontributory. At 26 weeks gestation, real-time and B-scan ultrasound examination revealed the absence of a cranium and other anomalies. Labor was induced with prostaglandin E2 suppositories, and the patient spontaneously delivered a female fetus with severe anomalies, which autopsy revealed to include encephalocele containing residual brain tissue, cleft lip and palate, gastroschisis, thoracoschisis, and agenesis of the left upper extremity. A 2-vessel umbilical cord was noted. Maternal serum and amniotic fluid alpha fetoprotein were more than 2 standard deviations from the normal mean for the gestational age. The case appears to support the finding in previous studies of an association between smoking more than 20 cigarettes/day, oral contraceptive use during pregnancy, and congenital malformations. Ultrasound should be offered as a fetal malformation screening technique during the 2nd trimester of pregnancy to women with a history of prenatal hormone exposure.