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Treatment of poor placentation and the prevention of associated adverse outcomes - what does the future hold?

Spencer, RN; Carr, DJ; David, AL; (2014) Treatment of poor placentation and the prevention of associated adverse outcomes - what does the future hold? Prenat Diagn , 34 (7) pp. 677-684. 10.1002/pd.4401. Green open access

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Abstract

Poor placentation, which manifests as pre-eclampsia and fetal growth restriction, is a major pregnancy complication. The underlying cause is a deficiency in normal trophoblast invasion of the spiral arteries, associated with placental inflammation, oxidative stress and an anti-angiogenic state. Peripartum therapies, such as antenatal maternal corticosteroids and magnesium sulphate, can prevent some of the adverse neonatal outcomes, but there is currently no treatment for poor placentation itself. Instead management relies on identifying the consequences of poor placentation in the mother and fetus, with iatrogenic preterm delivery to minimise mortality and morbidity. Several promising therapies are currently under development to treat poor placentation, to improve fetal growth, and to prevent adverse neonatal outcomes. Interventions such as maternal nitric oxide donors, sildenafil citrate, vascular endothelial growth factor gene therapy, hydrogen sulphide donors, and statins address the underlying pathology, while maternal melatonin administration may provide fetal neuroprotection. In the future these may provide a range of synergistic therapies for pre-eclampsia and fetal growth restriction, depending on the severity and gestation of onset. This article is protected by copyright. All rights reserved.

Type: Article
Title: Treatment of poor placentation and the prevention of associated adverse outcomes - what does the future hold?
Open access status: An open access version is available from UCL Discovery
DOI: 10.1002/pd.4401
Publisher version: http://dx.doi.org/10.1002/pd.4401
Additional information: © 2014 The Authors. Prenatal Diagnosis Published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL EGA Institute for Womens Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL EGA Institute for Womens Health > Maternal and Fetal Medicine
URI: https://discovery.ucl.ac.uk/id/eprint/1430672
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