Aspirin for the Prevention of Preeclampsia in Women With Abnormal Uterine Artery Doppler

Papaioannou, Spyros; Gee, Harry; Khan, Khalid S.

doi:10.1097/00006250-200111000-00028

Cited by 41 publications

(50 citation statements)

References 20 publications

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“…In fact, we showed that the incidence of preeclampsia was lower in the ASA group than in the control group. These findings were consistent with some recent studies regarding ASA therapy for prevention of preeclampsia, following uterine artery Doppler studies, which showed tendency towards benefit (29). In a study on 86 high-risk women with abnormal Doppler findings in 12-14 weeks of pregnancy, aspirin treatment resulted in lowering the risk of preeclampsia from 37.2% in the placebo group comparing to 11.6% in the aspirin group (34).…”

Section: Discussionsupporting

confidence: 91%

“…One study showed that taking 150 mg ASA daily after 23 week of gestation in patients with abnormal Doppler indices, did not stop progression of preeclampsia (28). Conversely, another study showed that ASA treatment resulted in a significant decrease of preeclampsia in patients with abnormal Doppler findings of uterine arteries (29). In 2000, Harrington et al published a paper in which the use of ASA in high risk patients, based on Doppler finding on the 20th week of gestation, did not make a significant difference on the incidence of preeclampsia, suggesting that future studies should aim on assessment of ASA usage early in pregnancy (30).…”

Section: Introductionmentioning

confidence: 99%

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

Talari¹,

Mesdaghinia²,

Abedzadeh-Kalahroudi³

2014

Iran Red Crescent Med J

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Background: Preeclampsia is one of the leading causes of maternal mortality and morbidity. Its prevalence varies between 10-25% among high-risk pregnant patients. Objectives: The aim of this study was to determine whether treatment with acetylsalicylic acid (ASA) reduces the incidence of preeclampsia among pregnant women with abnormal uterine artery flow. Patients and Methods:In this double-blind, placebo controlled trial, 80 high-risk pregnant women with preeclampsia, who had abnormal findings on Doppler ultrasonography at 12-16 weeks of pregnancy (unilateral notch with RI ≥ 0.65 or bilateral notch with RI ≥ 0.55), were randomly divided into two groups; the intervention group was treated with ASA tablet 80 mg, one tablet per day, and the control group was given placebo. Then patients were followed until the end of their pregnancy period, and pregnancy outcomes, including development of preeclampsia, the intrauterine growth retardation (IUGR), prematurity, type of delivery, birth weight, and Apgar score at one and five minutes were assessed. Data were analyzed using the student's t-test, chi-square or Fisher's exact test, and multivariate logistic regression. P values less than 0.05 were considered statistically significant. Results: There were no significant differences between the two groups in terms of baseline characteristics. There was a significant difference between the ASA and placebo groups in the incidence of preeclampsia (2.5% versus 22.5%), adjusting for the neonatal and maternal covariates. Conclusions: ASA prophylaxis can be used for prevention of preeclampsia in high-risk patients with abnormal uterine artery.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

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

Talari¹,

Mesdaghinia²,

Abedzadeh-Kalahroudi³

2014

Iran Red Crescent Med J

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“…44,45 Early identification of women at risk of pre-eclampsia facilitates targeted surveillance and intervention. 46,47 There are likely to be significant advantages in predicting preeclampsia in the first, as opposed to the second trimester; given that the disease process (failure of adequate trophoblastic invasion) is already established by the mid-second trimester, it seems likely that any successful preventative measure will need to be instituted as early in pregnancy as possible. Early prediction will also facilitate the investigation of prophylactic interventions in the future-it is possible that the earlier intervention is started the more likely it is to be effective.…”

Section: Discussionmentioning

confidence: 99%

Pulse wave analysis: a preliminary study of a novel technique for the prediction of pre‐eclampsia

Khalil

Cooper

Harrington

2008

BJOG

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Objective To investigate whether first-trimester arterial pulse wave analysis (PWA) can predict pre-eclampsia.Design This was a prospective screening study.Setting The Homerton University Hospital, a London teaching hospital.Population Two hundred and ten low-risk women with a singleton pregnancy were analysed.Methods Radial artery pulse waveforms were measured between the 11 +0 and 13 +6 weeks of gestation and the aortic waveform derived by applying a generalised transfer function. Augmentation pressure (AP) and augmentation index at heart rate of 75 beats per minute (AIx-75), measures of arterial stiffness, were calculated. The multiple of the gestation-specific median in controls for AP and AIx-75 were calculated. Logistic regression models were developed and their predictive ability assessed using the area under the receiver operator curve.Main outcome measures Prediction of pre-eclampsia by AIx-75.Results Fourteen (6.7%) women developed pre-eclampsia, and 196 remained normotensive. Eight of the 14 women developed pre-eclampsia before 34 weeks of gestation (early-onset pre-eclampsia). For a false-positive rate of 11%, AIx-75 had a detection rate of 79% for all cases of pre-eclampsia and 88% for early-onset pre-eclampsia.Conclusion First-trimester arterial PWA can play a significant role in understanding the pathophysiology of pre-eclampsia and may play a role in early screening.

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“…8 Accurate prediction of pre-eclampsia and intrauterine growth restriction is crucial to allow judicious allocation of resources for monitoring and preventive treatment to improve maternal and perinatal outcomes. 9,10 However, studies investigating the predictive accuracy of uterine artery Doppler indices (Box 1) have revealed considerably varied results. Thus, it is questionable whether uterine artery Doppler ultrasonography should be used as a predictive test.…”

Section: 5mentioning

confidence: 99%

Use of uterine artery Doppler ultrasonography to predict pre-eclampsia and intrauterine growth restriction: a systematic review and bivariable meta-analysis

Cnossen¹,

Morris²,

Riet³

et al. 2008

Canadian Medical Association Journal

643

403

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Background: : Alterations in waveforms in the uterine artery are associated with the development of pre-eclampsia and intrauterine growth restriction. We investigated the predictive accuracy of all uterine artery Doppler indices for both conditions in the first and second trimesters. Methods: :We identified relevant studies through searches of MEDLINE, EMBASE, the Cochrane Library and Medion databases (all records to April 2006) and by checking bibliographies of identified studies and consulting with experts. Four of us independently selected studies, extracted data and assessed study validity. We performed a bivariable meta-analysis of sensitivity and specificity and calculated likelihood ratios. Results:We identified 74 studies of pre-eclampsia (total 79 547 patients) and 61 studies of intrauterine growth restriction (total 41 131 patients). Uterine artery Doppler ultrasonography provided a more accurate prediction when performed in the second trimester than in the first-trimester. Most Doppler indices had poor predictive characteristics, but this varied with patient risk and outcome severity. An increased pulsatility index with notching was the best predictor of pre-eclampsia (positive likelihood ratio 21.0 among high-risk patients and 7.5 among low-risk patients). It was also the best predictor of overall (positive likelihood ratio 9.1) and severe (positive likelihood ratio 14.6) intrauterine growth restriction among low-risk patients.Interpretation: Abnormal uterine artery waveforms are a better predictor of pre-eclampsia than of intrauterine growth restriction. A pulsatility index, alone or combined with notching, is the most predictive Doppler index. These indices should be used in clinical practice. Future research should also concentrate on combining uterine artery Doppler ultrasonography with other tests. Abstract CMAJ 2008;178(6):701-11From the Departments of General Practice (Cnossen, ter Riet, Bindels), of Obstetrics and Gynaecology (Cnossen, Mol, van der Post) and

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Aspirin for the Prevention of Preeclampsia in Women With Abnormal Uterine Artery Doppler

Cited by 41 publications

References 20 publications

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

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

Pulse wave analysis: a preliminary study of a novel technique for the prediction of pre‐eclampsia

Use of uterine artery Doppler ultrasonography to predict pre-eclampsia and intrauterine growth restriction: a systematic review and bivariable meta-analysis

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