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Original Article

Pravastatin to prevent recurrent fetal death in massive perivillous fibrin deposition of the placenta (MPFD)

Tinnakorn ChaiworapongsaPerinatology 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, ;Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA,

Roberto RomeroPerinatology 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, ;Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA, ;Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA, ;Department of Molecular Obstetrics and Genetics, Wayne State University, Detroit, MI, USA, Correspondence[email protected] [email protected]

Steven J. KorzeniewskiPerinatology 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, ;Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA, ;Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA,

Piya ChaemsaithongPerinatology 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, ;Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA,

Edgar Hernandez-AndradePerinatology 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, ;Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA,

James H. SegarsProgram in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA,

Alan H. DeCherneyProgram in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA,

M. Cathleen McCoyPerinatal Unit, Winchester Obstetrics and Gynecology, Winchester Medical Center, Winchester, VA, USA, and

Chong Jai KimPerinatology 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, ;Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea

Lami YeoPerinatology 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, ;Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA,

Sonia S. HassanPerinatology 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, ;Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA,

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Figures & data

Figure 1. Histopathological examination of the placenta from a previous pregnancy showed fibrinoid deposition (arrow) in the intervillous space surrounding more than 50% of the villi in some full-thickness sections (H&E; 40×) (a) and absence of physiologic transformation of a spiral artery, i.e. persistent muscularization (circle) in the basal plate (H&E, 100×) (b).

Figure 2. Maternal plasma concentrations (log base e) of soluble vascular endothelial growth factor receptor -1 (sVEGFR-1) (a), placental growth factor (PlGF) (b), soluble endoglin (sEng) (c) and the ratio of PlGF/sVEGFR-1 (d) throughout pregnancy plotted against reference ranges at 2.5th 5th, 10th, 50th, 90th, 95th, and 97.5th percentile of uncomplicated pregnancies.

Table 1. Plasma concentrations (percentile for gestational age) of angiogenic and anti-angiogenic factors.

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Figure 3. Histopathological examination of the placenta from the current pregnancy reveals fibrinoid deposition (arrow) in the intervillous space, involving 20% of the villi (a) and areas with normal intervillous space (b) (H&E, 100×). Small and poorly developed villi (circle) or distal villous hypoplasia (H&E, 100×) are shown in (c). (d) Displays well-developed villi at 34 weeks of gestation (H&E, 100×).

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Pravastatin to prevent recurrent fetal death in massive perivillous fibrin deposition of the placenta (MPFD)

Table 1. Plasma concentrations (percentile for gestational age) of angiogenic and anti-angiogenic factors.

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Pravastatin to prevent recurrent fetal death in massive perivillous fibrin deposition of the placenta (MPFD)

Figures & data

Table 1. Plasma concentrations (percentile for gestational age) of angiogenic and anti-angiogenic factors.

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