This is an Open Access article distributed under the terms of the Creative Commons Attribution License (creativecommons.org/licenses/by/3.0) Conflict of interest: None declared | Source of funding: Nil | DOI: http://dx. Abstract: The primary physical characteristic of Binder syndrome is midfacial hypoplasia and flattened nose associated with the absence of the anterior nasal spine. Binder syndrome is a rare developmental defect which has many etiologies including vitamin K deficiency which may

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... ccur following warfarin intake during first trimester. It is rare disorder occurring in less than 1 per 10,000 live births. Common differential diagnosis includes CDPR (chondrodysplasia punctata, rhizomelic type) and fetal warfarin syndrome. We hereby report a case diagnosed antenatally as Binder syndrome in a fetus of woman suffering from rheumatic heart disease, who took warfarin in first trimester because of mechanical mitral valve prosthesis. This case is presented to highlight the teratogenic potential of warfarin and importance of preconceptional counseling by cardiologist and obstetrician and also to suggest the role of vitamin K deficiency in facial dysmorphism in Binder Syndrome.