Prediction and prevention of ischemic placental disease.
Preeclampsia, intrauterine growth restriction (IUGR), and placental abruption are obstetrical conditions that constitute the syndrome of ischemic placental disease or IPD, the leading cause of indicated preterm birth and an important cause of neonatal morbidity and mortality. While the phenotypic manifestations vary significantly for preeclampsia, IUGR, and abruption, these conditions may share a common underlying etiology as evidenced by: (1) shared clinical risk factors, (2) increased recurrence risk across pregnancies as well as increased co-occurrence of IPD conditions within a pregnancy, and (3) findings that suggest the underlying pathophysiologic processes may be similar. IPD is of major clinical importance and accounts for a large proportion of indicated preterm delivery ranging from the periviable to late preterm period. Successful prevention of IPD and resultant preterm delivery could substantially improve neonatal and maternal outcomes. This article will review the following topics: (1) The complicated research literature on aspirin and the prevention of preeclampsia and IUGR. (2) Research evidence on other medical interventions to prevent IPD. (3) New clinical interventions currently under investigations, including statins. (4) Current clinical recommendations for prevention of ischemic placental disease.
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY 10032. Electronic address: Alexander.Friedman@gmail.com.
Alexander M
AM
Friedman
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY 10032.
Kirsten L
KL
Cleary
D000037:Abruptio Placentae / Q000503:physiopathology / Q000517:prevention & control*; D000925:Anticoagulants / Q000627:therapeutic use; D001205:Ascorbic Acid / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D002136:Calcium, Dietary / Q000627:therapeutic use; D019587:Dietary Supplements; D015525:Fatty Acids, Omega-3 / Q000627:therapeutic use; D005260:Female; D005317:Fetal Growth Retardation / Q000503:physiopathology / Q000517:prevention & control*; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D007511:Ischemia / Q000503:physiopathology / Q000517:prevention & control*; D010920:Placenta / Q000098:blood supply*; D010922:Placenta Diseases / Q000503:physiopathology / Q000517:prevention & control*; D011225:Pre-Eclampsia / Q000503:physiopathology / Q000517:prevention & control*; D011247:Pregnancy; D047928:Premature Birth; D012307:Risk Factors; D014810:Vitamin E / Q000627:therapeutic use
D000925:Anticoagulants; D002136:Calcium, Dietary; D015525:Fatty Acids, Omega-3; D005343:Fibrinolytic Agents; D014810:Vitamin E; D001205:Ascorbic Acid; D001241:Aspirin
Indicated preterm birth; Ischemic placental disease; Preeclampsia prevention