EP08.09: Does low dose aspirin effect mean uterine artery Doppler pulsatility index in women deemed high risk for early pre‐eclampsia?

Abstract

Electronic poster abstractsfrom both sides of the bladder. The presence of SUA was also checked at the second (18-21 weeks) scan and after delivery by visual assessment of placenta. Concordance between first and second trimester findings was compared. Results: Prevalence of SUA was 0.92%. In 8.7% of cases the number of vessels in the cord was not possible to assess. Sensitivity, specificity, positive and negative predictive value for the finding in the first trimester were 92, 99.8, 79 and 99.9% respectively. In 31% of cases the fetus had associated malformations. With an ultrasound at 12-14 weeks most of the cases with significant fetal malformation were diagnosed. There was high concordance between the findings in the first and second trimester scan (coefficient of correlation 0.89). Conclusions: SUA is a useful marker for fetal malformation in the first trimester. It allows detection of a large number of cases with malformations before 20 weeks of gestation.The diagnosis of SUA at the first trimester scan is accurate and reproducible in the second trimester, so we could recommend to include its assessment into the protocol of 11-13 weeks scan. EP08.07Estimation of gestational age at 11 to 13 + 6 weeks of gestation using fetal biparietal diameter in a Korean population Objectives: To evaluate fetal biparietal diameter (BPD) between 11 and 13 + 6 weeks' gestation in pregnant Korean women after in vitro fertilisation (IVF), to construct reference charts for estimation of gestational age and to compare these charts with well-established standards. Methods: Data were retrospectively collected on 536 singleton Korean pregnancies conceived after IVF that underwent sonography between 11 and 13 + 6 weeks' gestation. The BPD was measured from the outer to the inner edge of the parietal bone in a transverse plane. Gestational age was calculated by adding 14 to the number of days between the date of oocyte retrieval and the date of the ultrasound scan. Results: We developed a new chart of BPD for the Korean population to estimate gestational age between 11 and 13 + 6 weeks. The BPD of Korean pregnancies was similar to previously described estimations at 11 weeks of gestation, but tended to be greater with advancing gestational age than those predicted by the formulas of Selbing and Kjessler. The best-fit equation for estimation of gestational age from BPD was GA (day) = 83.3571 − (0.8742 × BPD) + (0.0498 × BPD 2 ); and SD = −0.09850 + (0.08659 × BPD). Conclusions:The described chart may improve the accuracy of estimating GA in Korean pregnant women in the late first trimester.Supporting information can be found in the online version of this abstract Objectives: Assessing the angiogenic factors levels and the Doppler parameters in healthy controls and fetal growth restriction (FGR). Methods: This case-control study included 66 patients with diagnosis of FGR and 64 healthy pregnancies at 24-41 weeks of gestation. For both groups, maternal circulating concentrations of angiogenic factors of soluble fms-like tyrosine kinase-...

Reply

“…In relation to our comment that "aspirin may facilitate early placental embedding," they present evidence 5 they propose refutes the concept that aspirin might facilitate spiral arterial remodeling, or "physiological change." Specifically, they refer to their own work 5 and interpret their findings to mean aspirin did not change uteroplacental resistance (measured by Doppler ultrasound) by 24 weeks' gestation. Given this, McMaster-Fay and Hyett 1 propose the more likely mechanism of action by which aspirin prevents preeclampsia is platelet inhibition.…”

“…We respectfully disagree the work they cite 5 represents particularly definitive evidence that aspirin has no effect on placental embedding. It is an unpublished conference abstract and the data are not derived from a clinical trial where women were randomized to receive aspirin or placebo.…”

“…These spiral arterioles, where physiological change has not occurred, can then undergo atheromatous-like disease termed "acute atherosis." 5 This results in a further restriction of blood flow and even complete vascular occlusion. 2 Our uterine artery Doppler observations of patients at high risk of preeclampsia at 12 weeks' gestation 6 were that both patients treated with aspirin and those not treated showed a reduction in uteroplacental resistance toward the expected median at 24 weeks' gestation.…”

Comment on: Preventing preeclampsia with aspirin: does dose or timing matter?

“…5 This results in a further restriction of blood flow and even complete vascular occlusion. 2 Our uterine artery Doppler observations of patients at high risk of preeclampsia at 12 weeks' gestation 6 were that both patients treated with aspirin and those not treated showed a reduction in uteroplacental resistance toward the expected median at 24 weeks' gestation. Also there was no significant difference between the observational and aspirin-treated cohorts.…”

Pelvic floor trauma and maternal age

“…However, there is evidence in the literature that, at least in some populations, sphincter trauma may indeed be more prevalent in older women having their first child, 1-3 and this also seems to be the case for levator trauma. [4][5][6] Hence, we would like to reiterate the main conclusion of our article: advancing maternal age increases the risks of multiple negative birth outcomes, including pelvic floor trauma, and such increased risk should be disclosed antenatally. The risk profile of vaginal vs cesarean birth clearly varies from one individual to the next, and one of the main variables is maternal age.…”