Tarim Ebru, Bal Nebil, Kilicdag Esra, Kayaselcuk Fazilet, Bağiş Tayfun, Kuscu Esra
Department of Obstetrics and Gynecology, Baskent University, Baraj yolu.1.durak Seyhan, Adana 1000, Turkey.
Arch Gynecol Obstet. 2006 Jul;274(4):209-14. doi: 10.1007/s00404-006-0162-y. Epub 2006 Apr 29.
The aim of this study was to compare a low-dose aspirin treatment on placental and perinatal effects in the patients with poor obstetric history such as preeclampsia, intrauterine growth retardation (IUGR) in previous pregnancy.
This retrospective study of 86 pregnant women was conducted between April 2002 and June 2005. In this study period 364 placentas were examined and the patients with poor obstetric history such as IUGR and preeclampsia were selected. Then the patients were assigned to three groups; group 1 (n = 30) was composed of women with no risk in previous pregnancy; group 2 (n = 27) was composed of patients with poor obstetric history (e.g., preeclampsia, IUGR) who were treated with aspirin and patients in group 3 (n = 29) had poor obstetric history without any treatment (patients who were started to follow-up after 14 weeks of gestation). Patients in group 2 were treated with a low-dose aspirin (80 mg/day) as soon as a urinary pregnancy test was positive. Treatment was usually stopped at 34 completed weeks of gestation. On histopathologic examination of the placenta, uteroplacental vascular pathologic features and secondary villous damage (such as fibrinoid necrosis of desidual vessels, villous infarct, severely increased villous fibrosis, severely increased syncytiotrophoblast knotting, obliteration of the vessel lumen, severely increased villous hypervascularity) and also lesions involving coagulation (such as excessive perivillous fibrin deposition, multiple occlusive thrombi in uteroplacental vessels, avascular villi ) were examined.
There were no significant differences between the groups with respect to maternal age, body mass index at the first trimester and delivery. Also there were no significant differences among groups with respect to placental weight, fetal height, weight, gestational week, umbilical artery pH, pO2, pCO2 and base excess status. The incidences of preeclampsia were 3.3, 7.4, 6.8% and the incidences of IUGR were 6.7, 11.1, 6.8% in the groups, respectively (P > 0.05 for both). Although the percentages of all pathologic findings were higher in groups 2 and 3, these differences were not statistically important.
When low-dose aspirin is taken, starting at the beginning of pregnancy in patients with poor obstetric history, there are still high frequencies of uteroplacental vascular and related villous lesions persisted on placental bed. Also it has no beneficial effects on perinatal outcomes in these patients.
本研究旨在比较低剂量阿司匹林治疗对有不良产科病史（如子痫前期、既往妊娠胎儿宫内生长受限[IUGR]）患者胎盘及围产期的影响。
本回顾性研究于2002年4月至2005年6月对86名孕妇进行。在此研究期间，检查了364个胎盘，并选取了有IUGR和子痫前期等不良产科病史的患者。然后将患者分为三组；第1组（n = 30）由既往妊娠无风险的女性组成；第2组（n = 27）由有不良产科病史（如子痫前期、IUGR）且接受阿司匹林治疗的患者组成，第3组（n = 29）有不良产科病史但未接受任何治疗（妊娠14周后开始随访的患者）。第2组患者尿妊娠试验阳性后即开始服用低剂量阿司匹林（80毫克/天）。治疗通常在妊娠34周结束时停止。对胎盘进行组织病理学检查，检查子宫胎盘血管病理特征和次级绒毛损伤（如残留血管的纤维素样坏死、绒毛梗死、绒毛纤维化严重增加、合体滋养细胞结节严重增加、血管腔闭塞绒毛血管过度增加）以及涉及凝血的病变（如绒毛周围纤维蛋白过度沉积、子宫胎盘血管内多个闭塞性血栓、无血管绒毛）。
各组在产妇年龄、孕早期体重指数和分娩方面无显著差异。各组在胎盘重量、胎儿身高、体重、孕周、脐动脉pH值、pO2、pCO2和碱剩余状态方面也无显著差异。各组子痫前期的发生率分别为3.3%、7.4%、6.8%，IUGR的发生率分别为6.7%、11.1%、6.8%（两者P均>0.05）。虽然第2组和第3组所有病理结果的百分比更高，但这些差异无统计学意义。
对于有不良产科病史的患者，在妊娠开始时服用低剂量阿司匹林，胎盘床仍存在子宫胎盘血管及相关绒毛病变的高发生率。而且对这些患者的围产期结局没有有益影响。
