Effect of Low Dose Aspirin in Low Risk Pregnant Ladies with Abnormal Uterine Artery Doppler Results, and the Evaluation of Maternal and Fetal outcomes: A Randomized Clinical Trial
https://doi.org/10.24017/science.2018.2.14
Abstract views: 1224 / PDF downloads: 746Abstract
This study aimed to identify the effect of low dose aspirin administration in low risk pregnant ladies who have abnormal uterine artery Doppler results. Patients and Methods: A randomized clinical trial was performed on 50 pregnant ladies (?16 weeks of gestation) in Sulaymaniyah Maternity Teaching Hospital during January 2017 to January 2018. The participants were randomly enrolled into two groups; the participants in the first group were given 100 mg of aspirin tablet each but the other group was given nothing. Results: Preeclampsia was significantly (P-value of <0.001) less in the aspirin group as compared to the other group (16% and 40% respectively). The pulsatility index (PI) was not significantly different in both the groups (P-value = 0.69), but resistance index (RI) was significantly lower in the aspirin group (P-value of <0.001). Conclusion: Doppler study of the uterine artery at 16 weeks or higher in low risk pregnant women appears to be useful as a screening test and low dose of aspirin therapy at early stage of pregnancy will decrease the incidence of preeclampsia.
Keywords:
Aspirin, Doppler ultrasonography, Low risk pregnancy, Preeclampsia, Pulsatility index (PI), Resistance index (RI).
References
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https://doi.org/10.1172/JCI110576
[2] M. H. F. Sullivan, A. Zosmer, R. P. Gleeson, M. G. Elder. " Equivalent Inhibition of in vivo Platelet Function by Low Dose and High Dose Aspirin Treatment," Prostaghdins, Leukotrienes and Essential Fatty Acids, Vol. 39, pp. 319-321, 1990.
https://doi.org/10.1016/0952-3278(90)90012-A
[3] L. Duley. "Pre-eclampsia and the hypertensive disorders of pregnancy," British medical bulletin, Vol. 67, pp. 161-176, 2003.
https://doi.org/10.1093/bmb/ldg005
[4] I. Cetin, B. Huppertz, G. Burton et al. " Pregenesys pre-eclampsia markers consensus meeting: What do we require from markers, risk assessment and model systems to tailor preventive strategies?" Placenta, Vol. 32, pp. S4-S16, 2011.
https://doi.org/10.1016/j.placenta.2010.11.022
[5] G. ALBAIGES, H. MISSFELDER-LOBOS, C. LEES, M. PARRA, K. H. NICOLAIDES. "One-Stage Screening for Pregnancy Complications by Color Doppler Assessment of the Uterine Arteries at 23 Weeks' Gestation," Obstetrics & Gynecology, VOL. 96, NO. 4, pp. 559-564, Oct. 2000.
https://doi.org/10.1097/00006250-200010000-00015
[6] A. M. Martin, R. Bindra, P. Curcio, S. Cicero, K. H. Nicolaides. "Screening for pre?eclampsia and fetal growth restriction by uterine artery Doppler at 11-14 weeks of gestation," Obstetrics & Gynecology, Vol. 18, NO. 6, pp. 583-586, Dec. 2001.
https://doi.org/10.1046/j.0960-7692.2001.00594.x
[7] J. A. G. Alves, B. Y. D. C. Silva, P. C. P. D. Sousa, S. B. Maia, F. D. S. Costa. "Reference range of uterine artery Doppler parameters between the 11th and 14th pregnancy weeks in a population sample from Northeast Brazil," Revista Brasileira de Ginecologia e Obstetr'?cia. vol. 35, NO. 8, 2013.
https://doi.org/10.1590/S0100-72032013000800004
[8] O. Gomez, F. Figueras, S. Fernandez et al. "Reference ranges for uterine artery mean pulsatility index at 11-41 weeks of gestation," Ultrasound in Obstetrics & Gynecology, Vol. 32, NO. 2, pp. 128-132, 2008.
https://doi.org/10.1002/uog.5315
[9] J. Lefebvre, S. Demers, E. Bujold et al. "Comparison of two different sites of measurement for transabdominal uterine artery Doppler velocimetry at 11-13 weeks," Ultrasound in Obstetrics and Gynecology, Vol. 40, NO. 3, pp. 288-292, 2012.
https://doi.org/10.1002/uog.11137
[10] B. M. Sibai, R. Mirro, C.M. Chesney, C. Leffler. "Low-dose aspirin in pregnancy," Obstetrics & Gynecology. Vol. 74, pp. 551-557, 1989.
[11] Italian study of aspirin in pregnancy. "Low-dose aspirin in prevention and treatment of intrauterine growth retardation and pregnancy-induced hypertension," Lancet. Vol. 341, pp. 396-400, 1993.
https://doi.org/10.1016/0140-6736(93)92988-6
[12] S. Caritis, B. Sibai, J. Hauth et al. "Low-Dose Aspirin to Prevent Preeclampsia in Women at High Risk," N Engl J Med, Vol. 338, pp. 701-705, 1998.
https://doi.org/10.1056/NEJM199803123381101
[13] C. K. H. Yu, A. T. Papageorghiou, M. Parra, R. Palma Dias, K. H. Nicolaides. "Randomized controlled trial using low-dose aspirin in the prevention of pre-eclampsia in women with abnormal uterine artery Doppler at 23 weeks' gestation," Ultrasound in Obstetrics and Gynecology, Vol. 22, pp. 233-239, 2003.
https://doi.org/10.1002/uog.218
[14] H. Schulman, A. Fleischer, G. Farmakides et al. "Development of uterine artery compliance in pregnancy as detected by Doppler ultrasound," American Journal of Obstetrics & Gynecology, Vol. 155, pp. 1031-1036, 1986.
https://doi.org/10.1016/0002-9378(86)90340-6
[15] A. T. Papageorghiou, C. K.H. Yu, I. E. Erasmus, H. S. Cuckle, K. H. Nicolaides."Assessment of risk for the development of pre-eclampsia by maternal characteristics and uterine artery Doppler," BJOG: an International Journal of Obstetrics and Gynaecology, Vol. 112, pp. 703-709, 2005.
https://doi.org/10.1111/j.1471-0528.2005.00519.x
[16] S. Bower, S. Bewley, S. Campbell. "Improved prediction of preeclampsia by two-stage screening of uterine arteries using the early diastolic notch and color Doppler imaging," Obstetrics & Gynecology, Vol. 82, pp. 78-83, 1993.
[17] C. Lees. "Uterine artery Doppler: time to establish the ground rules," Ultrasound in Obstetrics and Gynecology, Vol. 16, pp. 607-609, 2000.
https://doi.org/10.1046/j.1469-0705.2000.00328.x
[18] P. F. Chien, N. Arnott, A. Gordon, P. Owen, K. Khon. "How useful is uterine artery Doppler flow velcimetryin the prediction of preeclampsia, intrauterine growth retardation and perinatal death? An overview," BJOG: an International Journal of Obstetrics and Gynaecology, Vol. 107, pp. 196-208, 2000.
https://doi.org/10.1111/j.1471-0528.2000.tb11690.x
[19] A. Benigni, G. Gregorini, T. Frusca, et al. "Effect of low-dose aspirin on fetal and maternal generation of thromboxane by platelets in women at risk for pregnancy-induced hypertension," N Engl J Med. Vol. 321, pp. 357-362, 1989.
https://doi.org/10.1056/NEJM198908103210604
[20] F. Goffinet, D. Aboulker, J. Paris-Llado, et al. "Screening with a uterine Doppler in low risk pregnant women followed by low dose aspirin in women with abnormal results: a multicenter randomized controlled trial," BJOG. Vol. 108, pp. 510-518, 2001.
https://doi.org/10.1016/S0306-5456(00)00116-9
[21] P. F. Chien, N. Arnott, A. Gordon, P. Owen, K. S. Khan. "How useful is uterine artery Doppler flow velocimetry in the prediction of pre-eclampsia, intrauterine growth retardation and perinatal death? An overview," BJOG. Vol. 107, pp. 196-208, 2000.
https://doi.org/10.1111/j.1471-0528.2000.tb11690.x
[22] A. M. Martin, R. Bindra, P. Curcio, S. Cicero, K. H. Nicolaides. "Screening for pre-eclampsia and fetal growth restriction by uterine artery Doppler at 11-14 weeks of gestation," Ultrasound Obstet Gynecol. Vol. 18, pp. 583-586, 2001.
https://doi.org/10.1046/j.0960-7692.2001.00594.x
[23] A. Coomarasamy, S. Papaioannou, H. Gee, K. S. Khan. "Aspirin for the prevention of preeclampsia in women with abnormal uterine artery Doppler: a meta-analysis," Obstetrics & Gynecology. Vol. 98 (5 Pt 1), pp. 861-866, 2001.
https://doi.org/10.1097/00006250-200111000-00028
[24] M. Vainio, E. Kujansuu, M. Iso-Mustajarvi, J. Maenpaa. "Low dose acetylsalicylic acid in prevention of pregnancy-induced hypertension and intrauterine growth retardation in women with bilateral uterine artery notches," BJOG. Vol. 109, pp. 161-167, 2002.
https://doi.org/10.1111/j.1471-0528.2002.01046.x
[25] K. Harrington, R. G. Carpenter, C. Goldfrad, S. Campbell. "Transvaginal Doppler ultrasound of the uteroplacental circulation in the early prediction of pre-eclampsia and intrauterine growth retardation," Br J Obstet Gynaecol. Vol. 104, pp. 674-681, 1997.
https://doi.org/10.1111/j.1471-0528.1997.tb11977.x
[26] K. Harrington, D. Cooper, C. Lees, K. Hecher, S. Campbell. "Doppler ultrasound of the uterine arteries: the importance of bilateral notching in the prediction of preeclampsia, placental abruption or delivery of a small-for-gestational-age baby," Ultrasound Obstet Gynecol. Vol. 7, pp. 182-188, 1996.
https://doi.org/10.1046/j.1469-0705.1996.07030182.x
[27] A. Antsaklis, G. Daskalakis, E. Tzortzis, S. Michalas. "The effect of gestational age and placental location on the prediction of pre-eclampsia by uterine artery Doppler velocimetry in low-risk nulliparous women" Ultrasound Obstet Gynecol. Vol. 16, pp. 635-639, 2000.
https://doi.org/10.1046/j.1469-0705.2000.00288.x
[28] F. De Wolf, C. De Wolf-Peeters, I. Brosens, W. B. Robertson. "The human placental bed: electron microscopic study of trophoblastic invasion of spiral arteries," Am J Obstet Gynecol. Vol. 137, pp. 58-70, 1980.
https://doi.org/10.1016/0002-9378(80)90387-7
[29] T. Y. Khong, F. De Wolf, W. B Robertson, I. Brosens. "Inadequate maternal vascular response to placentation in pregnancies complicated by pre-eclampsia and by small-for-gestational age infants," Br J Obstet Gynaecol. Vol. 93, pp. 1049-1059, 1986.
https://doi.org/10.1111/j.1471-0528.1986.tb07830.x
https://doi.org/10.1172/JCI110576
[2] M. H. F. Sullivan, A. Zosmer, R. P. Gleeson, M. G. Elder. " Equivalent Inhibition of in vivo Platelet Function by Low Dose and High Dose Aspirin Treatment," Prostaghdins, Leukotrienes and Essential Fatty Acids, Vol. 39, pp. 319-321, 1990.
https://doi.org/10.1016/0952-3278(90)90012-A
[3] L. Duley. "Pre-eclampsia and the hypertensive disorders of pregnancy," British medical bulletin, Vol. 67, pp. 161-176, 2003.
https://doi.org/10.1093/bmb/ldg005
[4] I. Cetin, B. Huppertz, G. Burton et al. " Pregenesys pre-eclampsia markers consensus meeting: What do we require from markers, risk assessment and model systems to tailor preventive strategies?" Placenta, Vol. 32, pp. S4-S16, 2011.
https://doi.org/10.1016/j.placenta.2010.11.022
[5] G. ALBAIGES, H. MISSFELDER-LOBOS, C. LEES, M. PARRA, K. H. NICOLAIDES. "One-Stage Screening for Pregnancy Complications by Color Doppler Assessment of the Uterine Arteries at 23 Weeks' Gestation," Obstetrics & Gynecology, VOL. 96, NO. 4, pp. 559-564, Oct. 2000.
https://doi.org/10.1097/00006250-200010000-00015
[6] A. M. Martin, R. Bindra, P. Curcio, S. Cicero, K. H. Nicolaides. "Screening for pre?eclampsia and fetal growth restriction by uterine artery Doppler at 11-14 weeks of gestation," Obstetrics & Gynecology, Vol. 18, NO. 6, pp. 583-586, Dec. 2001.
https://doi.org/10.1046/j.0960-7692.2001.00594.x
[7] J. A. G. Alves, B. Y. D. C. Silva, P. C. P. D. Sousa, S. B. Maia, F. D. S. Costa. "Reference range of uterine artery Doppler parameters between the 11th and 14th pregnancy weeks in a population sample from Northeast Brazil," Revista Brasileira de Ginecologia e Obstetr'?cia. vol. 35, NO. 8, 2013.
https://doi.org/10.1590/S0100-72032013000800004
[8] O. Gomez, F. Figueras, S. Fernandez et al. "Reference ranges for uterine artery mean pulsatility index at 11-41 weeks of gestation," Ultrasound in Obstetrics & Gynecology, Vol. 32, NO. 2, pp. 128-132, 2008.
https://doi.org/10.1002/uog.5315
[9] J. Lefebvre, S. Demers, E. Bujold et al. "Comparison of two different sites of measurement for transabdominal uterine artery Doppler velocimetry at 11-13 weeks," Ultrasound in Obstetrics and Gynecology, Vol. 40, NO. 3, pp. 288-292, 2012.
https://doi.org/10.1002/uog.11137
[10] B. M. Sibai, R. Mirro, C.M. Chesney, C. Leffler. "Low-dose aspirin in pregnancy," Obstetrics & Gynecology. Vol. 74, pp. 551-557, 1989.
[11] Italian study of aspirin in pregnancy. "Low-dose aspirin in prevention and treatment of intrauterine growth retardation and pregnancy-induced hypertension," Lancet. Vol. 341, pp. 396-400, 1993.
https://doi.org/10.1016/0140-6736(93)92988-6
[12] S. Caritis, B. Sibai, J. Hauth et al. "Low-Dose Aspirin to Prevent Preeclampsia in Women at High Risk," N Engl J Med, Vol. 338, pp. 701-705, 1998.
https://doi.org/10.1056/NEJM199803123381101
[13] C. K. H. Yu, A. T. Papageorghiou, M. Parra, R. Palma Dias, K. H. Nicolaides. "Randomized controlled trial using low-dose aspirin in the prevention of pre-eclampsia in women with abnormal uterine artery Doppler at 23 weeks' gestation," Ultrasound in Obstetrics and Gynecology, Vol. 22, pp. 233-239, 2003.
https://doi.org/10.1002/uog.218
[14] H. Schulman, A. Fleischer, G. Farmakides et al. "Development of uterine artery compliance in pregnancy as detected by Doppler ultrasound," American Journal of Obstetrics & Gynecology, Vol. 155, pp. 1031-1036, 1986.
https://doi.org/10.1016/0002-9378(86)90340-6
[15] A. T. Papageorghiou, C. K.H. Yu, I. E. Erasmus, H. S. Cuckle, K. H. Nicolaides."Assessment of risk for the development of pre-eclampsia by maternal characteristics and uterine artery Doppler," BJOG: an International Journal of Obstetrics and Gynaecology, Vol. 112, pp. 703-709, 2005.
https://doi.org/10.1111/j.1471-0528.2005.00519.x
[16] S. Bower, S. Bewley, S. Campbell. "Improved prediction of preeclampsia by two-stage screening of uterine arteries using the early diastolic notch and color Doppler imaging," Obstetrics & Gynecology, Vol. 82, pp. 78-83, 1993.
[17] C. Lees. "Uterine artery Doppler: time to establish the ground rules," Ultrasound in Obstetrics and Gynecology, Vol. 16, pp. 607-609, 2000.
https://doi.org/10.1046/j.1469-0705.2000.00328.x
[18] P. F. Chien, N. Arnott, A. Gordon, P. Owen, K. Khon. "How useful is uterine artery Doppler flow velcimetryin the prediction of preeclampsia, intrauterine growth retardation and perinatal death? An overview," BJOG: an International Journal of Obstetrics and Gynaecology, Vol. 107, pp. 196-208, 2000.
https://doi.org/10.1111/j.1471-0528.2000.tb11690.x
[19] A. Benigni, G. Gregorini, T. Frusca, et al. "Effect of low-dose aspirin on fetal and maternal generation of thromboxane by platelets in women at risk for pregnancy-induced hypertension," N Engl J Med. Vol. 321, pp. 357-362, 1989.
https://doi.org/10.1056/NEJM198908103210604
[20] F. Goffinet, D. Aboulker, J. Paris-Llado, et al. "Screening with a uterine Doppler in low risk pregnant women followed by low dose aspirin in women with abnormal results: a multicenter randomized controlled trial," BJOG. Vol. 108, pp. 510-518, 2001.
https://doi.org/10.1016/S0306-5456(00)00116-9
[21] P. F. Chien, N. Arnott, A. Gordon, P. Owen, K. S. Khan. "How useful is uterine artery Doppler flow velocimetry in the prediction of pre-eclampsia, intrauterine growth retardation and perinatal death? An overview," BJOG. Vol. 107, pp. 196-208, 2000.
https://doi.org/10.1111/j.1471-0528.2000.tb11690.x
[22] A. M. Martin, R. Bindra, P. Curcio, S. Cicero, K. H. Nicolaides. "Screening for pre-eclampsia and fetal growth restriction by uterine artery Doppler at 11-14 weeks of gestation," Ultrasound Obstet Gynecol. Vol. 18, pp. 583-586, 2001.
https://doi.org/10.1046/j.0960-7692.2001.00594.x
[23] A. Coomarasamy, S. Papaioannou, H. Gee, K. S. Khan. "Aspirin for the prevention of preeclampsia in women with abnormal uterine artery Doppler: a meta-analysis," Obstetrics & Gynecology. Vol. 98 (5 Pt 1), pp. 861-866, 2001.
https://doi.org/10.1097/00006250-200111000-00028
[24] M. Vainio, E. Kujansuu, M. Iso-Mustajarvi, J. Maenpaa. "Low dose acetylsalicylic acid in prevention of pregnancy-induced hypertension and intrauterine growth retardation in women with bilateral uterine artery notches," BJOG. Vol. 109, pp. 161-167, 2002.
https://doi.org/10.1111/j.1471-0528.2002.01046.x
[25] K. Harrington, R. G. Carpenter, C. Goldfrad, S. Campbell. "Transvaginal Doppler ultrasound of the uteroplacental circulation in the early prediction of pre-eclampsia and intrauterine growth retardation," Br J Obstet Gynaecol. Vol. 104, pp. 674-681, 1997.
https://doi.org/10.1111/j.1471-0528.1997.tb11977.x
[26] K. Harrington, D. Cooper, C. Lees, K. Hecher, S. Campbell. "Doppler ultrasound of the uterine arteries: the importance of bilateral notching in the prediction of preeclampsia, placental abruption or delivery of a small-for-gestational-age baby," Ultrasound Obstet Gynecol. Vol. 7, pp. 182-188, 1996.
https://doi.org/10.1046/j.1469-0705.1996.07030182.x
[27] A. Antsaklis, G. Daskalakis, E. Tzortzis, S. Michalas. "The effect of gestational age and placental location on the prediction of pre-eclampsia by uterine artery Doppler velocimetry in low-risk nulliparous women" Ultrasound Obstet Gynecol. Vol. 16, pp. 635-639, 2000.
https://doi.org/10.1046/j.1469-0705.2000.00288.x
[28] F. De Wolf, C. De Wolf-Peeters, I. Brosens, W. B. Robertson. "The human placental bed: electron microscopic study of trophoblastic invasion of spiral arteries," Am J Obstet Gynecol. Vol. 137, pp. 58-70, 1980.
https://doi.org/10.1016/0002-9378(80)90387-7
[29] T. Y. Khong, F. De Wolf, W. B Robertson, I. Brosens. "Inadequate maternal vascular response to placentation in pregnancies complicated by pre-eclampsia and by small-for-gestational age infants," Br J Obstet Gynaecol. Vol. 93, pp. 1049-1059, 1986.
https://doi.org/10.1111/j.1471-0528.1986.tb07830.x
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[1]
P. Jalal Ali and C. Najmaddin Fattah, “Effect of Low Dose Aspirin in Low Risk Pregnant Ladies with Abnormal Uterine Artery Doppler Results, and the Evaluation of Maternal and Fetal outcomes: A Randomized Clinical Trial”, KJAR, vol. 3, no. 2, pp. 85–89, Jul. 2018, doi: 10.24017/science.2018.2.14.
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23-07-2018
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