title: Pravastatin to prevent recurrent fetal death in massive perivillous fibrin deposition of the placenta (MPFD).
abstract: Massive perivillous fibrin deposition of the placenta (MPFD) or maternal floor infarction (MFI) is a serious condition associated with recurrent complications including fetal death and severe fetal growth restriction. There is no method to evaluate the risk of adverse outcome in subsequent pregnancies, or effective prevention. Recent observations suggest that MFI is characterized by an imbalance in angiogenic/anti-angiogenic factors in early pregnancy; therefore, determination of these biomarkers may identify the patient at risk for recurrence. We report the case of a pregnant woman with a history of four consecutive pregnancy losses, the last of which was affected by MFI. Abnormalities of the anti-angiogenic factor, sVEGFR-1, and soluble endoglin (sEng) were detected early in the index pregnancy, and treatment with pravastatin corrected the abnormalities. Treatment resulted in a live birth infant at 34 weeks of gestation who had normal biometric parameters and developmental milestones at the age of 2. This is the first reported successful use of pravastatin to reverse an angiogenic/anti-angiogenic imbalance and prevent fetal death.
authors.affiliation: a Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health , Bethesda, MD and Detroit , MI , USA .|b Department of Obstetrics and Gynecology , Wayne State University , Detroit , MI , USA .
authors.forename: Tinnakorn
authors.initials: T
authors.lastname: Chaiworapongsa
authors.affiliation: a Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health , Bethesda, MD and Detroit , MI , USA .|c Department of Obstetrics and Gynecology , University of Michigan , Ann Arbor , MI , USA .|d Department of Epidemiology and Biostatistics , Michigan State University , East Lansing , MI , USA .|e Department of Molecular Obstetrics and Genetics , Wayne State University , Detroit , MI , USA .
authors.forename: Roberto
authors.initials: R
authors.lastname: Romero
authors.affiliation: a Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health , Bethesda, MD and Detroit , MI , USA .|b Department of Obstetrics and Gynecology , Wayne State University , Detroit , MI , USA .|d Department of Epidemiology and Biostatistics , Michigan State University , East Lansing , MI , USA .
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Korzeniewski
authors.affiliation: a Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health , Bethesda, MD and Detroit , MI , USA .|b Department of Obstetrics and Gynecology , Wayne State University , Detroit , MI , USA .
authors.forename: Piya
authors.initials: P
authors.lastname: Chaemsaithong
authors.affiliation: a Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health , Bethesda, MD and Detroit , MI , USA .|b Department of Obstetrics and Gynecology , Wayne State University , Detroit , MI , USA .
authors.forename: Edgar
authors.initials: E
authors.lastname: Hernandez-Andrade
authors.affiliation: f Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health , Bethesda , MD , USA .
authors.forename: James H
authors.initials: JH
authors.lastname: Segars
authors.affiliation: f Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health , Bethesda , MD , USA .
authors.forename: Alan H
authors.initials: AH
authors.lastname: DeCherney
authors.affiliation: g Perinatal Unit , Winchester Obstetrics and Gynecology, Winchester Medical Center , Winchester , VA , USA , and.
authors.forename: M Cathleen
authors.initials: MC
authors.lastname: McCoy
authors.affiliation: a Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health , Bethesda, MD and Detroit , MI , USA .|h Department of Pathology , University of Ulsan College of Medicine, Asan Medical Center , Seoul , Korea.
authors.forename: Chong Jai
authors.initials: CJ
authors.lastname: Kim
authors.affiliation: a Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health , Bethesda, MD and Detroit , MI , USA .|b Department of Obstetrics and Gynecology , Wayne State University , Detroit , MI , USA .
authors.forename: Lami
authors.initials: L
authors.lastname: Yeo
authors.affiliation: a Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health , Bethesda, MD and Detroit , MI , USA .|b Department of Obstetrics and Gynecology , Wayne State University , Detroit , MI , USA .
authors.forename: Sonia S
authors.initials: SS
authors.lastname: Hassan
mesh_terms: D000026:Abortion, Habitual / Q000097:blood / Q000209:etiology* / Q000517:prevention & control*; D000328:Adult; D000818:Animals; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D010922:Placenta Diseases / Q000097:blood / Q000517:prevention & control*; D017035:Pravastatin / Q000494:pharmacology / Q000627:therapeutic use*; D011247:Pregnancy; D040281:Vascular Endothelial Growth Factor Receptor-1 / Q000097:blood
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D016756:Immunoglobulins, Intravenous; D040281:Vascular Endothelial Growth Factor Receptor-1; D017035:Pravastatin
keywords: Angiogenic factors; maternal floor infarction; placental growth factor; preeclampsia; proton pump inhibitor; soluble endoglin; soluble vascular endothelial growth factor receptor-1