Aspirin and Preeclampsia Prevention in Patients With Abnormal Uterine Artery Blood Flow

Talari, Hamid Reza; Mesdaghinia, Elaheh; Abedzadeh-Kalahroudi, Masoumeh

doi:10.5812/ircmj.7400

Cited by 18 publications

(17 citation statements)

References 40 publications

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“…Obesity was present in 30 (18.8 %) having mean body mass index 25.23 ± 1.92 kg/m 2 which is quite close to that reported by Talari et al 18 has also reported that 17% patients developed preeclampsia before 32 weeks of gestation.…”

Section: Discussionsupporting

confidence: 82%

“…Ebrashy et al 16 has also reported 28.4 % previous history of pre-eclampsia while 20.4 % family history of preeclampsia; close to our results. Talari et al 18 has also reported similar results.…”

Section: Discussionmentioning

confidence: 52%

“…Schwarzman et al 17 has also reported 2.76 ± 2.33 mean parity while mean gravidity was 3.32 ± 2.84. Talari et al 18 has also reported that 37.5 % patients with abnormal uterine artery Doppler had parity equal/more than 3.…”

Section: Discussionmentioning

confidence: 91%

“…Ebrashy et al 16 has reported mean age as 28.5 ± 5.9 years. Schwarzman et al 17 has also reported mean age as 27.30 ± 6.44 years while Talari et al 18 has reported it to be 27.8 ± 4.5 years.…”

Section: Discussionmentioning

confidence: 96%

“…9 Traditionally, pre-eclampsia is believed to be caused by certain underlying conditions such as; abnormalities in placental formation, by abnormal trophoblast patterns of spiral arteries and enhanced resistance observed in the uteroplacental circulation. 10 Pregnancies associated with higher diastolic blood flow velocity and early diastolic notch up to 22 weeks of pregnancy have been found to result in normal term deliveries whereas those pregnancies which exhibit increased resistance waveforms having early diastolic notch have been reported to be destined to result in increased rates of preterm deliveries, placental abruption and IUGR due to pre-eclampsia. 11 Barati et al 12 reported as high as 88.2 % pre-eclampsia in patients with abnormal uterine artery Doppler.…”

Section: Introductionmentioning

confidence: 99%

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Frequency of pre-eclampsia in patients with abnormal uterine artery Doppler at twenty two to twenty four weeks of gestation.

Tabassum

Mumtaz

Fayyaz

et al. 2020

TPMJ

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Objectives: To determine the frequency of pre-eclampsia among pregnant ladies with abnormal uterine artery Doppler at 22- 24 weeks of gestation at a tertiary care hospital. Study Design: Cross sectional study. Setting: Department of Obstetrics and Gynecology, Nishtar Medical University / Hospital Multan. Period: All the women (n=160) with abnormal uterine artery from 01-07-2018 to 30-06-2019 were included. Material & Methods: The pulsatility index (PI) of uterine artery Doppler was taken by taking average of 3 consecutive waveforms to determine the abnormal uterine artery Doppler. These study cases were followed till delivery to document pre-eclampsia. Results: Of these 160 study cases, 89 (55.6 %) had gestational age up to 23 weeks while 71 (44.4 %) had gestational age more than 23 weeks having mean age of 25.44 ± 4.77 years. Of these 160 pregnant ladies with abnormal uterine artery Doppler, 72 (45.0 %) were resident of rural areas and 88 (55.0 %) were resident of urban areas and family history of pre-eclampsia was 42 (26.3%). Previous history of pre-eclampsia was noted in 41 (25.6%). Mean parity was 2.24 ± 1.06 and 113 (70.6%) had parity up to 3. Mean gravidity of our study cases was 3.87 ± 1.16 and 89 (55.6%) had gravidity up to 4. Obesity was present in 30 (18.8 %) having mean body mass index 25.23 ± 1.92 kg/m2. Mean interpregnancy interval was 14.19 ± 6.82 months and 83 (51.9 %) had interpregnancy interval more than 1 year and pre-eclampsia was noted in 125 (78.1%). Conclusion: Very high frequency of pre-eclampsia was noted in our study in pregnant women presenting with abnormal uterine artery Doppler at 22 – 24 weeks of gestation. Pre-eclampsia was significantly associated with age, family history of pre-eclampsia, previous history of pre-eclampsia and interpregnancy interval.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Frequency of pre-eclampsia in patients with abnormal uterine artery Doppler at twenty two to twenty four weeks of gestation.

Tabassum

Mumtaz

Fayyaz

et al. 2020

TPMJ

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Antiplatelet agents for preventing pre-eclampsia and its complications

Duley

Meher

Hunter

et al. 2019

Cochrane Database of Systematic Reviews

205

210

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Aspirin in the prevention of pre-eclampsia in high-risk women* Sir, We thank Dr Thornton for his interest in our article 'Aspirin in the prevention of pre-eclampsia in high-risk women' published in the January 2013 issue of BJOG. 1 He raises four points we would like to respond to: the strength of effect; sample size; exclusion of participants from the main analysis; and trial registration.Dr Thornton concludes the commentary by writing that the effect of aspirin we reported in the meta-analysis for women who also have abnormal uterine artery Doppler waveforms at 14 weeks of gestation differs little from its effect in other high-risk groups. We have difficulty in agreeing with this; in our opinion the risk ratio in our meta-analysis (RR 0.55; 95% CI 0.37-0.83) differs from those reported by the Cochrane review. 2,3 The differences are even better encapsulated by comparing the numbers needed to treat (NNTs). In our meta-analysis, the substantial reduction in risk together with the high initial risk (36%) resulted in an NNT of six for preventing preeclampsia, whereas the Cochrane review reported an NNT for pre-eclampsia of 19 for women at high risk (20% risk) and 119 for women at moderate risk (6%), and concluded that 'further information is required to assess which women are most likely to benefit, when treatment is best started, and at what dose'. The PARIS meta-analysis reported a 10% reduction and an NNT of 56 for women at high risk (18% risk) and 167 for women at moderate risk (6%).In other respects our study represents both the strengths and weaknesses of clinician-initiated trials. With limited funding, from non-commercial sources only, the participating clinicians in ten centres were able to screen 947 women whose history indicated an increased risk of pre-eclampsia, to find those whose uterine artery flow indicates a particularly high risk. As we discuss in the article, in hindsight the criterion chosen was too strict, and only 152 women could be randomised. Although Dr Thornton is correct in stating that 31 of these women discontinued the treatment for various reasons and were excluded from the main analysis, he seems to overlook our description of the intention-to-treat analysis of all randomised women (except those who had a miscarriage), which gave a similar result. We do agree about the shortcomings of the information included in the ISRCTN registration (www.controlled-trials.com/ISRCTN140 30412/), submitted by one member of the study team. For example, variables that were eventually listed in the outcomes section include predictor variables such as biochemical measurements during pregnancy. It should also be noted that the planned number of participants stated on the ISRCTN website, of 1000 women, refers to the women to be screened by Doppler ultrasound, and not those to be eventually randomised, as Dr Thornton stated in his commentary.In our conclusion we echoed the words of the Cochrane review that 'further information is required to assess which women are most likely to benefit', and proposed that...

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Pharmacological Interventions for the Prevention of Fetal Growth Restriction: A Systematic Review and Network Meta‐Analysis

Bettiol

Avagliano

Lombardi

et al. 2021

Clin Pharma and Therapeutics

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The prevention of fetal growth restriction (FGR) is challenging in clinical practice. To date, no meta-analysis summarized evidence on the relative benefits and harms of pharmacological interventions for FGR prevention. We performed a systematic review and network meta-analysis (NetMA), searching PubMed, Embase, Cochrane Library, and ClinicalTrials. gov from inception until November 2019. We included clinical trials and observational studies on singleton gestating women evaluating antiplatelet, anticoagulant, or other treatments, compared between each other or with controls (placebo or no treatment), and considering the pregnancy outcome FGR (primary outcome of the NetMA). Secondary efficacy outcomes included preterm birth, placental abruption, and fetal or neonatal death. Safety outcomes included bleeding and thrombocytopenia. Network meta-analyses using a frequentist framework were conducted to derive odds ratios (ORs) and 95% confidence intervals (CIs). Of 18,780 citations, we included 30 studies on 4,326 patients. Low molecular weight heparin (LMWH), alone or associated with low-dose aspirin (LDA), appeared more efficacious than controls in preventing FGR (OR 2.00, 95% CI 1.27-3.16 and OR 2.67, 95% CI 1.21-5.89 for controls vs. LMWH and LDA + LMWH, respectively). No difference between active treatments emerged in terms of FGR prevention, but estimates for treatments other than LMWH +/-LDA were imprecise. Only the confidence in the evidence regarding LMWH vs. controls was judged as moderate, according to the Confidence in Network Meta-Analysis framework. No treatment was associated with an increased risk of bleeding, although estimates were precise enough only for LMWH. These results should inform clinicians on the benefits of active pharmacological prophylaxis for FGR prevention.Fetal growth restriction (FGR) is a relatively common pregnancy complication and is usually defined based on the discrepancy between actual and expected fetal ultrasound biometric measurements for a given gestational age. 1 Fetuses with FGR do not achieve the genetically predetermined growth potential as a result of maternal (e.g., undernutrition, exposure to toxins,

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Aspirin and Preeclampsia Prevention in Patients With Abnormal Uterine Artery Blood Flow

Cited by 18 publications

References 40 publications

Frequency of pre-eclampsia in patients with abnormal uterine artery Doppler at twenty two to twenty four weeks of gestation.

Frequency of pre-eclampsia in patients with abnormal uterine artery Doppler at twenty two to twenty four weeks of gestation.

Antiplatelet agents for preventing pre-eclampsia and its complications

Pharmacological Interventions for the Prevention of Fetal Growth Restriction: A Systematic Review and Network Meta‐Analysis

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