BackgroundPreterm preeclampsia is an important cause of maternal and perinatal death and complications. It is uncertain whether the intake of low-dose aspirin during pregnancy reduces the risk of preterm preeclampsia. MethodsIn this multicenter, double-blind, placebo-controlled trial, we randomly assigned 1776 women with singleton pregnancies who were at high risk for preterm preeclampsia to receive aspirin, at a dose of 150 mg per day, or placebo from 11 to 14 weeks of gestation until 36 weeks of gestation. The primary outcome was delivery with preeclampsia before 37 weeks of gestation. The analysis was performed according to the intention-to-treat principle. ResultsA total of 152 women withdrew consent during the trial, and 4 were lost to follow up, which left 798 participants in the aspirin group and 822 in the placebo group. Preterm preeclampsia occurred in 13 participants (1.6%) in the aspirin group, as compared with 35 (4.3%) in the placebo group (odds ratio in the aspirin group, 0.38; 95% confidenc...

Aspirin versus Placebo in Pregnancies at High Risk for Preterm Preeclampsia

VTE, Thrombophilia, Antithrombotic Therapy, and Pregnancy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines

Prevention of preeclampsia and intrauterine growth restriction with aspirin started in early pregnancy: a meta-analysis

Objective: This guideline summarizes the quality of the evidence to date and provides a reasonable approach to the diagnosis, evaluation, and treatment of the hypertensive disorders of pregnancy (HDP). Evidence: The literature reviewed included the original HDP guidelines and their reference lists and an update from 1995. Using key words, Medline was searched for literature published between 1995 and 2007. Articles were restricted to those published in French or English. Recommendations were evaluated using the criteria of the Canadian Task Force on Preventive Health Care (Table 1).

https://www.mcgill.ca/anesthesia/files/anesthesia/wk_5b_sogc_guidelines.pdf

Diagnosis, Evaluation, and Management of the Hypertensive Disorders of Pregnancy

The role of aspirin dose on the prevention of preeclampsia and fetal growth restriction: systematic review and meta-analysis

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1538-7836.2008.03230.x

Dalteparin for the prevention of recurrence of placental-mediated complications of pregnancy in women without thrombophilia: a pilot randomized controlled trial.

Objectives To study the platelet function response to low-dose ASA with the Platelet Function Analyzer (PFA-100) in pregnant women and to identify maternal characteristics associated with non-responsiveness. Methods We conducted a prospective cohort study involving 87 pregnant women on ASA. The platelet function response to ASA was measured as the closure time obtained with epinephrine cartridges (CT-EPI) by the PFA-100. Non-response to ASA was defined as a CT-EPI ≤ 150 seconds after four weeks of therapy. Non-responders were given an escalating dose of ASA and their CT-EPI was tested again. Results After four weeks of enteric-coated ASA 81mg daily, 25/87 women (28.7%) were non-responders (95% CI 16.1 to 41.4). Among these women, a CT-EPI ≤ 150 seconds was found in 8/24 women (33.3%) after another four weeks of alternating ASA 81mg and 162mg daily. After a further four-week course of ASA 162mg daily, a CT-EPI ≤ 150 seconds was found in 3/6 women (50.0%). Among the women who initially responded and who were reassessed at 24–32 weeks of pregnancy, the CT-EPI was ≤ 150 seconds in 9/36 (25.0%). There was no statistical difference in maternal characteristics between ASA responders and non-responders. Conclusion A significant number of pregnant women showed a lack of platelet function response to ASA 81mg that was in most cases overcome with higher dosing. Furthermore, the prevalence of non-responsiveness increased with advancing pregnancy.

Low-dose ASA response using the PFA-100 in women with high-risk pregnancy.

Hypercalcemia in pregnancy is an uncommon event that can cause major maternal morbidity and/or fetal or neonatal morbidity and mortality. Management is a challenge for the clinicians, especially as regards to investigations in pregnancy, surgery, and the use of cinacalcet and bisphosphonates. We present three case reports and discuss management.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/ccr3.646

Hypercalcemia in pregnancy - a multifaceted challenge: case reports and literature review.

Objective: To explore the difference between distinct methods of assessing blood pressure (BP) in pregnant women with different hypertensive disorders. Methods: We compared office BP to home patient- and nurse-measured diastolic BP in pregnant women with essential chronic hypertension (CH), preeclampsia (PE) and isolated hypertension (IOH). Results: Office BP was lower or similar to home patient- and nurse-measured BP in women with CH. Office BP was higher than home patient-measured BP in women with PE and in women with IOH (p < 0.0001). Nurse-measured BP was higher than patient-measured BP in women with PE (p < 0.01). Conclusions: BP assessments in women with PE are significantly influenced by the environment, which should be considered in managing these women.

Francine Morin

Papers

Dalteparin for the prevention of recurrence of placental-mediated complications of pregnancy in women without thrombophilia: a pilot randomized controlled trial.

Low-dose ASA response using the PFA-100 in women with high-risk pregnancy.

Hypercalcemia in pregnancy - a multifaceted challenge: case reports and literature review.

Blood pressure assessments in different subtypes of hypertensive pregnant women: office versus home patient- or nurse-measured blood pressure.

Obstetric and cardiac outcomes in women with Marfan syndrome and an aortic root diameter ≤ 45mm