EP17.28: Hemodynamic changes in uteroplacental and fetal circulation after administration of pravastatin and L‐arginine in second trimester of pregnancy

The aim of our study was to investigate the effects of pravastatin / L-arginine therapy on uteroplacental and fetal circulation administered to patients with increased uterine artery resistance in second trimester of pregnancy. In this prospective study 21 patient with increased uterine artery resistance mean Pulsatility index above 95% for gestational age in second trimester of pregnancy were included. Upon detection of increased resistance in uterine arteries, 40mg Pravastatin and 1500mg Larginine were administered to pregnant patients from second trimester to delivery. Patients were followed up to delivery and uterine artery pulsatility (PI) and resistance index (Ri) were measured every 2-4 weeks. Umbilical artery, cerebral artery, aorta and renal artery pulsatility indices were also measured in regular intervals. Delivery was performed when cardiotocography showed imminent hyoxia or at term. Median patient's age was 33 (24-42) years. Median gestational age at detection of increased resistance was 19 (16-24) weeks. Mean uterine artery Ri at the inclusion of the study was 0.79 ± 0.08. Mean uterine artery Pi was 2.13 ± 0.63. Diastolic notching was present in all patients. Improvement in uterine artery circulation was registered after 3 weeks. Increased uterine artery resistance was registered until delivery. In fetal circulation umbilical artery PI remained in normal value range until delivery. Median cerebral artery, aortal and renal PI remained also in normal range until delivery. Mean gestational age at delivery was 36 weeks. Mean neonatal weight was 2,428 ± 1,037 g. Caesarean section rate was 66%. Mean Apgar score was 8/9. Preterm delivery rate due to imminent fetal hypoxia was 38%. Administration of pravastatin / L-arginine therapy in second trimester of pregnancy achieved vasodilatatory effects in umbilical and fetal circulation. This therapy postponed deterioration in fetal and umbilical circulation due to vasoconstriction registered in uteroplacental circulation.