Hamid R, Robson M, Pearce J M
Department of Obstetrics and Gynaecology, St. George's Hospital Medical School, London, UK.
Br J Obstet Gynaecol. 1994 Jun;101(6):481-4. doi: 10.1111/j.1471-0528.1994.tb13145.x.
To investigate the use of low dose aspirin in the reduction of perinatal morbidity and mortality in women with unexplained raised maternal serum alpha-fetoprotein and abnormal uteroplacental Doppler waveform patterns.
Prospective randomised controlled trial.
A tertiary referral obstetric service.
One hundred and sixty-four women referred to our unit with raised maternal serum alpha-fetoprotein and a structurally normal fetus had abnormal uteroplacental Doppler waveform patterns at 24 weeks of gestation.
Women were randomly allocated to two groups, receiving either low dose aspirin 75 mg (n = 76) or placebo (n = 88) daily until delivery.
Preterm labour, low birthweight, the occurrence of placental abruptions and perinatal mortality.
The frequency of severely small for gestational age infants (birthweight < 5th centile) was reduced in the aspirin treated group to 16% compared with 25% in the placebo group (95% CI-21% to 13%). The frequency of delivery before 34 weeks of gestation was 26% in the aspirin group and 42% in the placebo group (95% CI--30% to 1%). The perinatal mortality was 240/1000 in the aspirin group and 320/1000 in the placebo group (95% CI--22% to 6%). None of these reductions was statistically significant. Although the frequency of placental abruptions was similar in the two groups, significantly more babies died from abruption in the aspirin treated group (91% versus 30%, 95% CI 28% to 94%). Low dose aspirin did cause a significant reduction (P = 0.008) in deaths from causes other than placental abruption.
This trial revealed a benefit of low dose aspirin therapy in women with raised maternal serum alpha-fetoprotein and abnormal uteroplacental Doppler waveform patterns, but the effect was smaller than expected. Although a reduction in deaths from small preterm babies was observed, there was an increase in the number of deaths following placental abruption without a significant increase in the number of abruptions. We recommend that this should be considered before giving aspirin to these high risk women and that other investigators should specifically look for this effect.
探讨低剂量阿司匹林对母血清甲胎蛋白升高且子宫胎盘多普勒波形模式异常的孕妇围产期发病率和死亡率的降低作用。
前瞻性随机对照试验。
一家三级转诊产科服务机构。
164名转诊至我院的孕妇，其母血清甲胎蛋白升高且胎儿结构正常，在妊娠24周时子宫胎盘多普勒波形模式异常。
将孕妇随机分为两组，一组每天服用75毫克低剂量阿司匹林（n = 76），另一组服用安慰剂（n = 88），直至分娩。
早产、低出生体重、胎盘早剥的发生率及围产期死亡率。
阿司匹林治疗组小于胎龄儿（出生体重<第5百分位数）的发生率降至16%，而安慰剂组为25%（95%可信区间为-21%至13%）。阿司匹林组妊娠34周前分娩的发生率为26%，安慰剂组为42%（95%可信区间为-30%至1%）。阿司匹林组围产期死亡率为240/1000，安慰剂组为320/1000（95%可信区间为-22%至6%）。这些降低均无统计学意义。虽然两组胎盘早剥的发生率相似，但阿司匹林治疗组因胎盘早剥死亡的婴儿明显更多（91%对30%，95%可信区间为28%至94%）。低剂量阿司匹林确实使非胎盘早剥原因导致的死亡显著降低（P = 0.008）。
本试验显示低剂量阿司匹林治疗对母血清甲胎蛋白升高且子宫胎盘多普勒波形模式异常的孕妇有益，但效果小于预期。虽然观察到小早产儿死亡有所减少，但胎盘早剥后的死亡人数增加，且早剥次数无显著增加。我们建议在给这些高危孕妇使用阿司匹林之前应考虑这一点，其他研究者应特别关注这种效应。
