Screening for Preeclampsia in the First Trimester and Aspirin Prophylaxis: Our First Year

Abstract

Objective Preeclampsia is a major cause of perinatal and maternal morbidity and mortality. Our objective is to assess the performance of a combined screening test for preeclampsia in the first trimester and the prophylactic use of low-dose aspirin. Methods Prospective study of all women attending our hospital for the first-trimester screening of aneuploidies, between March 2017 and February 2018 (n = 1,297). The exclusion criteria were multiple pregnancy and major fetal abnormalities. Preeclampsia screening was performed with an algorithm that includes maternal characteristics, and biophysical and biochemical biomarkers. High-risk was defined as a risk ≥ 1:50 of early-onset preeclampsia (before 34 weeks), in which cases low-dose aspirin (150 mg at night) was offered to these women from screening until 36 weeks. Results From the 1,272 enrolled participants, the majority were Caucasian (1,051; 82.6%) and multiparous (658, 51.7%). Fifty patients (3.9%) screened high-risk for preeclampsia, and all started a low-dose aspirin regimen, with good compliance (96%). Early-onset preeclampsia was found in 3 pregnant women (0.24%), and total preeclampsia was diagnosed in 25 (2.02%), compared with 28 (0.75%) cases of early preeclampsia (p = 0.0099) and 98 (2.62%) of total preeclampsia (p = 0.2904) before the implementation of screening. Conclusion There was a lower incidence of both, early-onset and total preeclampsia, after the introduction of universal screening and prophylactic use of low-dose aspirin. This reduction was statistically significant in early-onset preeclampsia. The association of a first-trimester combined screening model and aspirin prophylaxis appears to be useful in predicting and reducing the incidence of early-onset preeclampsia, in a routine care setting.

Assistência de enfermagem í s mulheres com pré-eclampsia: revisão integrativa

“…Rastreio de pré-eclâmpsia no primeiro trimestre e profilaxia com aspirina: O nosso primeiro ano (5) Portugal 2020…”

“…Também se associa a pré-eclâmpsia, mesmo com ausência de proteinúria, valores laboratoriais anormais, especificamente plaquetopenia e hepatocitose, além do surgimento de sinais ou sintomas de envolvimento de órgãos-alvo, por exemplo, comprometimento renal identificado como insuficiência aguda através da dosagem de eletrólitos. (5,8) A pré-eclâmpsia está associada a maior chance de parto prematuro, baixo peso ao nascer e morte fetal. É importante realizar o tratamento e cuidados para diminuição dos riscos e agravamentos, durante as consultas clinicas deve-se identificar as mulheres que precisarão de uma vigilância mais cuidadosa, aumentando o número de consultas pré--natais de 4 em 4 semanas até 27 semanas, a cada 2 semanas entre 28 e 35 semanas e semanalmente a partir de 36 semanas.…”

“…Pode ser mantido até o final da gestação, mas também é válida a suspensão após 36 semanas, para renovação completa das plaquetas para o momento do parto. No que se refere a suplementação de cálcio, o estudo associa uma redução nos riscos da pré-eclâmpsia acompanhada de uma dieta baixa em cálcio, a suplementação pode variar de 1 a 2 g. (5) Peçaroli et.al (15) , ainda ressalta que a assistência pré-natal não deve apenas conter ações preventivas, mas também reduzir progressão de patologias para formas mais graves, como a eclampsia. O sulfato de magnésio deve ser incluído no cuidado da assistência de enfermagem como a melhor opção de prevenção e tratamento, sendo recomendado o uso em pacientes com pré-eclâmpsia, especialmente para pressão arterial de difícil controle.…”

First trimester screening for preeclampsia: a cost-effectiveness cohort study

“…Physician compliance of 96 to 99% has meanwhile been demonstrated with implementation of the FMF algorithm. 9,11 Although we didn't assess patient compliance in this study, it's clear that physician compliance with prescribing aspirin does not equate with patient compliance. In an observational cohort study, 44% of women identified as high-risk using maternal characteristics alone, were not compliant with the use of aspirin.…”

Level of knowledge on preeclampsia symptoms, complications, and risk factors among women in Saudi Arabia: A cross sectional study

“…The prognosis correlates directly with this classification since early onset PET is linked to more serious complications and poor maternal and neonatal outcomes (Lisonkova and Joseph, 2013). A study by (Lourenço et al, 2020) showed that the first trimester screening of PET, which combines maternal factors, obstetric and medical history, and biochemical and biophysical markers, is useful for predicting early onset PET in a routine care setting. Therefore, the first trimester combination test with maternal risk factors and biomarkers should be used as a one step procedure to screen all pregnant women for preterm PET during early pregnancy (Poon et al, 2019).…”