Sharma Nidhi, Srinivasan Sunayana, Srinivasan K Jayashree, Nadhamuni Kulasekaran
1Department of Obstetrics and Gynaecology, Saveetha Medical College, Saveetha University, Chennai, 602105 India.
No 5 Jayanthi Street, Velachery, Chennai 600042 India.
J Obstet Gynaecol India. 2018 Oct;68(5):382-388. doi: 10.1007/s13224-017-1058-4. Epub 2017 Nov 7.
Preeclampsia is a heterogeneous disorder prevalent in 3-10% of pregnant women globally. The etiology is multifactorial. There is a initial stage of endothelial dysfunction and placental ischemia (Stage 1); this leads to maternal syndrome of hypertension, edema, and proteinuria (Stage 2). Drugs acting on immunomodulatory, anti-inflammatory, antioxidant and proresolving pathways can minimize the complications of preeclampsia. The therapeutic effect of aspirin is based on acetyl group and salicylate group. Both components have independent therapeutic effects on anti-inflammatory pathway and proresolving pathway.
This study was designed to assess the effectiveness and safety of aspirin in prevention and treatment of symptoms and complications of preeclampsia in women at high risk of preeclampsia.
This is a prospective experimental study to evaluate the effectiveness of aspirin versus placebo in the prevention of maternal syndrome of preeclampsia in women with high risk of preeclampsia (G1 = 97, G2 = 92). Patients with age ≥ 34, chronic hypertension, multiple pregnancies, gestational diabetes, and high pulsatility index of uterine artery were enrolled between 12 and 20 weeks of gestation and prescribed 75 mg aspirin daily till 34 weeks of gestation. Control group was not prescribed aspirin.
There was a reduction in relative risk of preeclampsia in aspirin group as compared with control group. There was no significant increase in the number of cases of abruption placenta, preterm delivery, neonatal intraventricular hemorrhage, patent ductus arteriosus, and postpartum hemorrhage following aspirin therapy.
In patients with high mean pulsatility index of uterine arteries, low dose aspirin can be a useful intervention. Uterine artery Doppler is a simple and noninvasive test which can be used safely for the prediction of preeclampsia. Aspirin is safe, economical, and easily available commercially.
子痫前期是一种异质性疾病，全球3%-10%的孕妇中普遍存在。其病因是多因素的。存在内皮功能障碍和胎盘缺血的初始阶段（1期）；这会导致母体出现高血压、水肿和蛋白尿综合征（2期）。作用于免疫调节、抗炎、抗氧化和促消退途径的药物可将子痫前期的并发症降至最低。阿司匹林的治疗作用基于乙酰基和水杨酸基团。这两种成分在抗炎途径和促消退途径上都有独立的治疗作用。
本研究旨在评估阿司匹林预防和治疗子痫前期高危女性子痫前期症状及并发症的有效性和安全性。
这是一项前瞻性实验研究，旨在评估阿司匹林与安慰剂在预防子痫前期高危女性（G1 = 97，G2 = 92）子痫前期母体综合征方面的有效性。年龄≥34岁、患有慢性高血压、多胎妊娠、妊娠期糖尿病以及子宫动脉搏动指数高的患者在妊娠12至20周时入组，并每天服用75毫克阿司匹林直至妊娠34周。对照组未服用阿司匹林。
与对照组相比阿司匹林组子痫前期的相对风险有所降低。阿司匹林治疗后胎盘早剥、早产、新生儿脑室内出血、动脉导管未闭和产后出血的病例数没有显著增加。
对于子宫动脉平均搏动指数高的患者，低剂量阿司匹林可能是一种有效的干预措施。子宫动脉多普勒检查是一种简单且无创的检查，可安全用于子痫前期的预测。阿司匹林安全、经济且在商业上易于获得。
