title: Antithrombin improves the maternal and neonatal outcomes but not the angiogenic factors in extremely growth-restricted fetuses at <28 weeks of gestation.
abstract: OBJECTIVE
  Severe preterm fetal growth restriction (FGR) remote from term is problematic. We aimed to investigate the effect of maternally-administered antithrombin on maternal and neonatal outcomes. A prospective, one-arm, pilot study was performed in 14 women with severe FGR (≤5th centile) at <28 weeks of gestation, without hypertensive disorders. Maternal plasma concentrations of soluble Feline McDonough Sarcoma (FMS)-like trypsin kinase-1 (sFlt-1) and placental growth factor (PlGF) were measured and categorized into three groups: group 1; low sFlt-1 and high PlGF, group 2; moderate sFlt-1 and low PlGF, and group 3; high sFlt-1 and low PlGF. Antithrombin was administered for 3 days. The incidence of perinatal mortality, infant morbidity, and the period of pregnancy prolongation were compared.
  
  
  RESULTS
  In group 1 (n=4), their pregnancies were extended for longer periods and the maternal and infant outcomes were good. The prolongation periods were shorter in groups 2 (n=3) and 3 (n=7), which resulted in poor maternal [severe preeclampsia or hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome] and infant outcomes.
  
  
  CONCLUSIONS
  The evaluation of the maternal sFlt-1 and PlGF at 21-27 weeks of gestation is useful in the managements of severe FGR. Antithrombin treatment could prolong the pregnancies with low sFlt-1 and high PlGF without negatively affecting maternal or fetal health.
authors.affiliation: .
authors.forename: Midori
authors.initials: M
authors.lastname: Fujisaki
authors.affiliation: .
authors.forename: Ken
authors.initials: K
authors.lastname: Furuta
authors.affiliation: .
authors.forename: Masanao
authors.initials: M
authors.lastname: Ohhashi
authors.affiliation: .
authors.forename: Seishi
authors.initials: S
authors.lastname: Furukawa
authors.affiliation: .
authors.forename: Yuki
authors.initials: Y
authors.lastname: Kodama
authors.affiliation: .
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Kawagoe
authors.affiliation: .
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sameshima
authors.affiliation: .
authors.forename: Tsuyomu
authors.initials: T
authors.lastname: Ikenoue
mesh_terms: D000328:Adult; D000991:Antithrombins / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D005260:Female; D005317:Fetal Growth Retardation / Q000188:drug therapy*; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000097:blood / Q000517:prevention & control; D010865:Pilot Projects; D011247:Pregnancy; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D000991:Antithrombins; D015415:Biomarkers
keywords: Antithrombin; fetal growth restriction; perinatal mortality; placenta