For the past decades, growing attention has been given to aspirin use during pregnancy. It favors placentation by its proangiogenic, antithrombotic, and antiinflammatory effects. Therefore, low doses of aspirin are prescribed in the prevention of placenta-mediated complications, mainly preeclampsia and fetal growth restriction.However, questions regarding its clinical application are still debated. Aspirin is effective in preventing preeclampsia in a high-risk population. Most guidelines recommend that risk stratification should rely on medical history. Nevertheless, screening performances dramatically improve if biochemical and biophysical markers are included.Concerning the appropriate timing and dose, latest studies suggest aspirin should be started before 16 weeks of pregnancy and at a daily dose of 100 mg or more. Further studies are needed to improve the identification of patients likely to benefit from prophylactic aspirin. Besides, the role of aspirin in the prevention of fetal growth restriction is still questioned. | INTRODUCTIONPreeclampsia (PE) occurs in 3% to 5% of all pregnancies and is responsible for 70 000 maternal deaths worldwide each year. 1 It is a placenta-mediated complication causing a multisystem disorder.PE is defined as hypertension accompanied by one of the following after the 20th week of pregnancy: proteinuria, thrombocytopenia, renal insufficiency, impaired liver function, pulmonary edema, and new onset cerebral or visual symptoms. 2 Over the past decade, substantial advances have been made in understanding the pathophysiology of PE. 3 However, no curative treatment of PE has been found. Hence, to date, delivery of the placenta is the only treatment. Current management of preterm PE consists in balancing the risks of continuing pregnancy and iatrogenic prematurity. Given its major repercussions and the lack of curative treatment, predicting and preventing PE appear to be a major issue of modern obstetrics. 4Fetal growth restriction (FGR) complicates 5% to 10% of pregnancies. 5 It is a leading cause of premature birth and intrapartum hypoxia.Utero-placental insufficiency is the most common cause of FGR. [5][6][7] As with PE, there is no treatment to reverse placental-related fetal restriction. 8Aspirin has been used for its anti-inflammatory properties since time immemorial. For the last 70 years, it has been widely prescribed in the prevention of coronary and cerebrovascular complications.Early descriptions of PE refer to extensive placental thrombotic lesions. 9 Aspirin was therefore prescribed for its antithrombotic properties. The first evidence of aspirin efficacy in preventing PE was published in 1985. 10 Since then, numerous trials have assessed the efficacy of aspirin in preventing placenta-mediated complications. 11Nevertheless, its mechanism of action has not been fully elucidated, and questions regarding its clinical application remain unanswered. | BASIS OF PATHOPHYSIOLOGYPE originates in early stages of placentation. Placentation starts with extravillous trophoblast (EVT...
To evaluate women's choice in the method of labour induction between oral misoprostol, PGE2 pessary and the Foley catheter. To compare women's satisfaction according to their choice and to identify factors associated with patient satisfaction. MethodsWe conducted a comparative, prospective cohort study of 520 women who chose their preferred method for labour induction, in a French tertiary hospital, from July 2019 to October 2020. Before and after the delivery, they were asked to argument their choice and to evaluate their satisfaction through the use of questionnaires. The primary outcome was global level of satisfaction. ResultsOf the 520 women included, 67,5% of women chose oral Misoprostol compared to 21% PGE2 pessary and 11.5% the Foley catheter. Regarding global satisfaction, we found no signi cant difference between the three groups: 78,4%, 68,8% and 71,2% (p = 0,091) for respectively oral misoprostol, PGE2 pessary and the Foley catheter. Factors that seem to improve women's satisfaction were nulliparity (OR = 2.03, 95%CI[1.19-3.53]), delivery within 24 hours after the start of induction (OR = 3.46, 95%CI. [2.02-6.14]) and adequate information (OR = 4.21,). Factors associated with lower satisfaction rates were postpartum hemorrhage (OR = 0.51, 95%CI [0.30-0.88]) and caesarean section (OR = 0.31, 95%CI [0.17-0.54]). ConclusionWomen satisfaction rates were not different between the three methods, when chosen by the patients themselves. These nding should encourage caregivers to promote shared decision making when possible.
Intrapartum electronic fetal monitoring has become a standard of care in the assessment of fetal well-being during labour. 1 Despite extensive research on fetal heart rate (FHR) analysis, its interpretation is subject to low specificity and high interobserver variability, 2 and its effectiveness in reducing perinatal mortality and cerebral palsy remains
Objective To evaluate the risk of spontaneous preterm birth on subsequent pregnancies after second stage cesarean section. Methods This is a retrospective cohort study. Women were included if they had their two consecutive births in Toulouse University Hospital in the study period. The first birth was a singleton livebirth at term (≥37 weeks of gestation), divided in three categories according to the mode of delivery: vaginal delivery (group A), cesarean section before the second stage of labor (group B), cesarean section during the second stage of labor (group C). The subsequent pregnancy was the first subsequent pregnancy, conducted after 16 weeks of gestation. The primary outcome was spontaneous preterm birth in the subsequent pregnancy, defined as delivery before 37 weeks of gestation. Secondary endpoints included preterm rupture of membranes in the subsequent pregnancy. Results Between 2003 and 2018, 7776 women (84.7%) in group A, 1263 (13.8%) in group B and 143 (1.5%) in group C were included. The adjusted odds ratio of spontaneous preterm birth before 37 weeks of gestation after second stage cesarean section was 2.4 (group C vs group A + B, 95% confidence interval: 1.2–4.8), P = 0.01). The rate of preterm rupture of membranes was also significantly higher in group C (6% vs 2% in group A, P = 0.009, 6% vs 3% in group B, P= 0.05) with OR = 3.0 (group C vs group A + B, 95% CI: 1.55–6.16, P < 0.001). Conclusion History of term second stage of labor cesarean section is an independent risk factor for spontaneous preterm birth and for preterm rupture of membrane in the subsequent pregnancy.
In twin pregnancies, risk of severe postpartum hemorrhage increases from 2% for sums of birth weights less than 3,000 g to 9% for sums exceeding 6,500 g.
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