title: OS013. Reduction of preeclampsia related complications with with theNO-donor penterythriltetranitrat (petn) in risk pregnancies - Aprospective randomized double-blind placebo pilot study.
abstract: BACKGROUND
  NO-donors reduce the impedance in uteroplacental vessels. Consequently Lees et al. pilot study demonstrated that transdermal nitroglycerin positively influences pregnancy outcome within a high-risk collective. Furthermore the NO-donor pentaerythriltetranitrate additionally expresses cell stabilizing effects in endothelial cells.
  
  
  OBJECTIVE
  Hypothesizing an effect on endothelial health and uterine perfusion in pregnancies presented with pathological uterine perfusion at 20weeks of gestation we performed a randomized, prospective, and placebo-controlled, double-blind study implemented with the aim to investigate whether the oral NO-donor Pentalong(®) (PETN) is suitable as a prophylactic drug in abnormal placentation.
  
  
  METHODS
  We included 111 pregnancies presenting with abnormal placental perfusion (bilateral notch or mean RI>0.7) between the 19th and 24thweek of gestation (w.o.g.). Further risk factors (high-risk group: history of HELLP/preeclampsia/IUGR/IUFD/placental abruption, type I diabetes mellitus, hypertension, thrombosis/thrombophilia) were identified in 78 study participants. Fifty-four women received PETN 57 received placebo. Doppler velocimetry measurements of uteroplacental and fetal vessels and fetal growth scans were monitored biweekly with primary endpoints being the occurrence of preeclampsia, IUGR and/or premature birth.
  
  
  RESULTS
  Within the first week of intake, PETN improved uteroplacental perfusion significantly in comparison to placebo (mean PI 1.26±0.36 vs. 1.49±0.44; p< 0.01). Overall frequency of premature birth <32nd w.o.g.(4 vs. 12), IUGR <10th percentile (15 vs. 29) and preeclampsia (11 vs. 14) were reduced. Although reduction in preeclampsia was comparably low in those 25 patients developing preeclampsia the outcome was markedly improved in the PETN study group by reducing the frequency of IUGR (4 vs. 10), diagnosis of preeclampsia before 32 w.o.g. (3 vs. 7) and premature birth before 32 w.o.g. (1 vs. 6). Furthermore 4 fetal losses occurred in the study group all in the placebo group.
  
  
  CONCLUSIONS
  NO-donors constitute an interesting option in the prophylaxis of adverse pregnancy outcome related to abnormal placentation.
authors.affiliation: Obstetrics, Computer Sciences and Documentation, University Hosptial Jena, Friedrich Schiller University, Jena, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Groten
authors.affiliation: Obstetrics, Computer Sciences and Documentation, University Hosptial Jena, Friedrich Schiller University, Jena, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Fitzgerald
authors.affiliation: Institute of Medical Statistics, Computer Sciences and Documentation, University Hosptial Jena, Friedrich Schiller University, Jena, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Lehmann
authors.affiliation: Obstetrics, Computer Sciences and Documentation, University Hosptial Jena, Friedrich Schiller University, Jena, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Schneider
authors.affiliation: Center for Prenatal Diagnostics, Erfurt, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Kähler
authors.affiliation: Obstetrics, Computer Sciences and Documentation, University Hosptial Jena, Friedrich Schiller University, Jena, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Schleussner