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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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.

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Pravastatin for the prevention of adverse pregnancy outcome: preeclampsia and more?

Declaration of interest

The authors report no conflicts of interest. This research was supported, in part, by the Perinatology Research Branch, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, DHHS.

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

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

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