Antiplatelet agents for preventing pre-eclampsia and its complications

Duley, Lelia; Henderson‐Smart, David J; Meher, Shireen; King, James F.

doi:10.1002/14651858.cd004659.pub2

Cited by 549 publications

(447 citation statements)

References 134 publications

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“…Low-dose aspirin and heparin have been used to improve placental function and decrease stillbirth, but a high number needed to treat with aspirin and uncertain efficacy has prevented widespread adoption of these interventions. 74 Although evidence is incomplete, preconception care is a potentially valuable intervention in stillbirth prevention, yet only 28% of care providers said that preconception care for women with risk factors was implemented mostly or always in their facilities.…”

Section: Quality Of Care Uptake Of Interventions In Stillbirth Prevenmentioning

confidence: 99%

Stillbirths: recall to action in high-income countries

et al. 2016

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Variation in stillbirth rates across high-income countries and large equity gaps within high-income countries persist. If all high-income countries achieved stillbirth rates equal to the best performing countries, 19 439 late gestation (28 weeks or more) stillbirths could have been avoided in 2015. The proportion of unexplained stillbirths is high and can be addressed through improvements in data collection, investigation, and classification, and with a better understanding of causal pathways. Substandard care contributes to 20-30% of all stillbirths and the contribution is even higher for late gestation intrapartum stillbirths. National perinatal mortality audit programmes need to be implemented in all high-income countries. The need to reduce stigma and fatalism related to stillbirth and to improve bereavement care are also clear, persisting priorities for action. In high-income countries, a woman living under adverse socioeconomic circumstances has twice the risk of having a stillborn child when compared to her more advantaged counterparts. Programmes at community and country level need to improve health in disadvantaged families to address these inequities.

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Section: Quality Of Care Uptake Of Interventions In Stillbirth Prevenmentioning

confidence: 99%

Stillbirths: recall to action in high-income countries

et al. 2016

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“…While there is currently no effective preventative measure, a recent meta-analysis has suggested that low-dose aspirin may reduce the incidence of pre-eclampsia by 10%. 44,45 Early identification of women at risk of pre-eclampsia facilitates targeted surveillance and intervention. 46,47 There are likely to be significant advantages in predicting preeclampsia in the first, as opposed to the second trimester; given that the disease process (failure of adequate trophoblastic invasion) is already established by the mid-second trimester, it seems likely that any successful preventative measure will need to be instituted as early in pregnancy as possible.…”

Section: Discussionmentioning

confidence: 99%

Pulse wave analysis: a preliminary study of a novel technique for the prediction of pre‐eclampsia

Khalil

Cooper

Harrington

2008

BJOG

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Objective To investigate whether first-trimester arterial pulse wave analysis (PWA) can predict pre-eclampsia.Design This was a prospective screening study.Setting The Homerton University Hospital, a London teaching hospital.Population Two hundred and ten low-risk women with a singleton pregnancy were analysed.Methods Radial artery pulse waveforms were measured between the 11 +0 and 13 +6 weeks of gestation and the aortic waveform derived by applying a generalised transfer function. Augmentation pressure (AP) and augmentation index at heart rate of 75 beats per minute (AIx-75), measures of arterial stiffness, were calculated. The multiple of the gestation-specific median in controls for AP and AIx-75 were calculated. Logistic regression models were developed and their predictive ability assessed using the area under the receiver operator curve.Main outcome measures Prediction of pre-eclampsia by AIx-75.Results Fourteen (6.7%) women developed pre-eclampsia, and 196 remained normotensive. Eight of the 14 women developed pre-eclampsia before 34 weeks of gestation (early-onset pre-eclampsia). For a false-positive rate of 11%, AIx-75 had a detection rate of 79% for all cases of pre-eclampsia and 88% for early-onset pre-eclampsia.Conclusion First-trimester arterial PWA can play a significant role in understanding the pathophysiology of pre-eclampsia and may play a role in early screening.

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“…Descreve-se redução do risco de 17% no desenvolvimento de pré-eclampsia com o uso de agentes antiplaquetários 3 . Neste estudo, foi detectada redução significativa no desenvolvimento de pré-eclâmpsia grave após intervenção com enoxaparina, como se observa na Tabela 1.…”

Section: Discussionunclassified

“…Os agentes antiplaquetários também estão associados à redução no risco relativo (RR) de 8% no parto pré-termo, redução do RR de 14% para óbitos fetais/ perinatais e RR de 10% em recém-nascidos com baixo peso ao nascimento 3 . Esses resultados vêm ao encontro dos apresentados nesta pesquisa, uma vez que se observa redução significativa no número de abortos e óbitos fetais/ perinatais após instituição das estratégias de diagnóstico e intervenção para as trombofilias.…”

Section: Discussionunclassified

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Eficácia de intervenção com enoxaparina baseada em sistema de pontuação nos desfechos perinatais de gestantes com trombofilias

Figueiró-Filho¹,

Oliveira²,

Breda³

et al. 2012

Rev. Bras. Ginecol. Obstet.

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ResumoOBJETIVO: Avaliar se a intervenção com heparina de baixo peso molecular (HBPM) -enoxaparina sódica -foi eficaz na melhora dos desfechos perinatais de mulheres com trombofillias com base em sistema de pontuação. MÉTODOS: Estudo prospectivo, não randomizado, não controlado, realizado em um Ambulatório de Gestação de Alto Risco, durante o período de novembro de 2009 a novembro de 2011. Foram incluídas gestantes com diagnóstico e intervenção terapêutica para trombofilias adquiridas e/ou hereditárias na gestação atual. Os dados obstétricos e perinatais das gestantes anteriores à intervenção foram comparados com os desfechos subsequentes à intervenção, sendo analisados estatisticamente através do teste do χ 2 , com correção de Yates, considerando significativos quando p<0,05. A dosagem inicial de HBPM foi norteada por sistema de pontuação, baseado no histórico clínico e gestacional das pacientes, além de exames de rastreamento de trombofilias adquiridas e/ou hereditárias. RESULTADOS: Foram incluídas 84 mulheres grávidas com 175 gestações anteriores ao diagnóstico, das quais 20,0% resultaram em morte fetal ou perinatal, 40,0% resultaram em abortamento, 17,7% desenvolveram pré-eclâmpsia ou eclâmpsia, 10,3% foram partos a termo e 29,7% partos pré-termo. Nas 84 gestações após a intervenção, 6,0% resultaram em morte fetal ou perinatal, 1,2% em abortamento, 4,8% desenvolveram pré-eclâmpsia/eclâmpsia, 22,6% em parto prematuro e 70,2% parto a termo. Observou-se redução significativa na taxa de óbito fetal ou perinatal (p<0,05) e abortos (p<0,0001), e aumento significativo (p<0,05) no número de nascidos vivos após a intervenção. CONCLUSÃO: A intervenção baseada na enoxaparina utilizando um sistema de pontuação em gestantes com trombofilia mostrou-se eficaz na melhora do desfecho perinatal. Abstract PURPOSES:To assess whether an enoxaparin-based intervention using a score system was effective in improving perinatal outcome in women with thrombophilia. METHODS: Study Design: Prospective, not randomized, uncontrolled, performed at a Clinic of High-Risk Pregnancy from November 2009 to November 2011. We included women with a diagnosis and therapeutic intervention for thrombophilia acquired and/or inherited in the current pregnancy. The obstetric and perinatal outcomes of pregnant women before the intervention were compared with outcomes after the intervention, and statistically analyzed using the χ 2 test with Yates correction, considered significant when p<0.05. The initial dose of low-molecular-weight Heparin (LMWH) was guided by a scoring system based on the clinical and gestational history of the patients and screening tests for acquired and/or inherited thrombophilia. RESULTS: We included 84 pregnant women with 175 pregnancies before diagnosis, 20.0% of which resulted in fetal ou perinatal death, 40.0% resulted in abortion, 17.7% developed preeclampsia/eclampsia, 10.3% resulted in full-term births, and 29.7% in premature births. In the 84 pregnancies after intervention, 6.0% resulted in fetal ou perinatal death, 1.2% in ...

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Antiplatelet agents for preventing pre-eclampsia and its complications

Abstract: Antiplatelet agents, largely low-dose aspirin, have moderate benefits when used for prevention of pre-eclampsia and its consequences. Further information is required to assess which women are most likely to benefit, when treatment is best started, and at what dose.

Cited by 549 publications

References 134 publications

Stillbirths: recall to action in high-income countries

Stillbirths: recall to action in high-income countries

Pulse wave analysis: a preliminary study of a novel technique for the prediction of pre‐eclampsia

Eficácia de intervenção com enoxaparina baseada em sistema de pontuação nos desfechos perinatais de gestantes com trombofilias

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