الفهرس 
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Abstract
A randomized, double-blind, placebo-controlled, prospective, clinical study:
Aim of the study was to:
1- Evaluate the role of abnormal Doppler ultrasound in prediction of preeclampsia.
2-Assess the effect of oral low- dose of aspirin (75 mg/day) starting at 18th week of gestation on the development of preeclampsia when given to primigravide identified as being at high risk by abnormal Doppler ultrasound ,as well as, its effect on perinatal morbidity and mortality.
Subjects:
•The study was carried out on 120 selected primigravidae who attended the Obstetrics and Gynecology department in Benha University Hospitals during the period from October 1997 to April 1999. Selected primigravidae had a singleton pregnancy, normal blood pressure, 16-18 weeks’ pregnant, and had a protodiastolic notch in one, or both, uterine arteries by Doppler ultrasound examination.
Methods:
•Primigravidae were randomly divided into 2 matched groups. Group I: consisted of 60 primigravidae who were given aspirin (75 mg tablet/day), while group II: consisted of 60 primigravidae who were given a placebo (I tablet/day). Both groups were followed up by
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SUMMARY AND CONCLISION
regular antenatal care, conventional ultrasound and Doppler ultrasound of both uterine and umbilical arteries till delivery.
Results:
1- The incidence of PIH and preeclampsia later in pregnancy was found to be high among, primigravidae who had a unilateral, or bilateral, protodiastolic notch, at 16-18 weeks’ of pregnancy.
a-Incidence was 38.3% in the aspirin group and 68.3% in the placebo group (P < 0.05).
b-There was no significant difference between aspirin and placebo groups regarding the development of PIH or mild preeclampsia (10% in aspirin versus 11.6% in placebo for Pal and 18.3% in aspirin versus 25% in placebo for mild preeclampsia) (P < 0.05).
c-On the other hand, there was a statistically significant higher incidence of severe preelcampsia in placebo group (31.7%) compared to 10% in aspirin group (P < 0.05).
2-There was a statistically significant increase in uterine artery systolic/diastolic (S/D) ratio, resistance index (RI) and pulsatility index (PI) in primigravidae who developed Pill and preeclampsia compared to normal women, both in aspirin and placebo groups.
3-For evaluation of the predictive performance of abnormal uterine artery Doppler waveforms (protodiastolic notch, RI and S/D ratio), the present study showed that:
a- The protodiastolic notch (unilateral or bilateral) at 24 week was found to be a better predictor of PIH, or preeclampsia than that at 18 weeks’ gestation, both in aspirin and placebo groups.
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SUMMARY AND CONCLUSION
b-Bilateral notches were a much better predictor of PIH or
preeclampsia than a unilateral notch at 16-18 weeks and at 24 weeks, in both aspirin and placebo groups.
c-The protodiastolic notch was a better predictor of PIH or
preeclampsia than other uterine artery indices (RI and S/D ratio) at 16-18 weeks and at 24 weeks.
4- The portodiastolic notch, RI and S/D ratio were significantly better predictors of P114 or preeclampsia than the roll-over test done at 28 to 32 weeks, gestation (P < 0.05). However, the roll-over test was found to be positive in 57.1%, 60% and 83.3-94.7% in primigravidae who developed PIH, mild preeclampsia and severe preeclampsia respectively. Therefore, roll-over test should be used in centres in which Doppler ultrasound is not available as it could
predict the vast majority of primigravidae destined to have severe preeclampsia.
5-Regarding the diagnostic performance of umbilical artery Doppler
waveforms in PIH or preeclampsia, the current study showed a statistically significant increase in umbilical artery S/D ratio, RI and
PI in primigravidae who developed PIH or preeclampsia later in pregnancy compared with those who had normal blood pressure, both in aspirin and placebo groups.
6-In women defined as high risk for preeclampsia by the presence of protodiastolic notch and other Doppler indices. (RI and S/D ratio), low dose aspirin significantly reduced the incidence of severe
preeclampsia (10% in aspirin group versus 31.7% in placebo group, P < 0.01).
7-There was a statistically significant reduction in early onset of preeclampsia in primigravidae who received aspirin compared to
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SUMMARY AND CONCLUSION
those received a placebo (6.6% in the aspirin group versus 36.6% in the placebo group, P < 0.05).
8-There was a significant reduction in odds of preterm delivery, before 37 weeks (3.3% in the aspirin group versus 18.3% in the placebo group) and before 34 weeks (0% in the aspirin group versus 6.6% in the placebo group) (P < 0.05).
9-Babies in the aspirin group were 302 gm heavier than babies in the placebo group, but the difference was not statistically significant.
10-Aspirin was associated with less babies with intrauterine growth retardation compared to babies of the placebo group (3.3% in the aspirin group versus 6.6% in the placebo group), but this difference was not statistically significant.
11-Aspirin prophylaxis was not associated with any perinatal death in this study
12-There was no significant difference between aspirin and placebo groups regarding; Apgar score at 1 minute and at 5 minutes.
13-Aspirin did not increase the incidence of placental abruption, other antepartum haemorrhage or postpartum haemorrhage.
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SUMMARY AND CONCLUSION
Conclusion:
from the present study, it was possible to reach to the following inclusions:
1-Doppler velocity waveform analysis in the second trimester (16-18 weeks) is a non invasive, rapid, safe and inexpensive screening test to identify pregnant women at high risk of developing preeclampsia later in pregnancy.
2-Protodiastolic notch of the uterine artery is a better predictor of preeclampsia than other uterine indices (RI and S/D ratio), and bilateral notches are better predictor than unilateral notch. So, assessment of uterine arteries during pregnancy at 24 weeks for presence of unilateral or bilateral notches is adequate for prediction of development of PIH or peeclampsia in pregnant women and there is no need to perform other time consume uterine artery indices (RI and S/D ratio).
3-In centres where Doppler ultrasound is not available, the use of the roll-over test should be done in all primigravidae at 28-32 weeks. This test can pick up the great majority of primigravidae (about 83.3 — 94.7%) destined to have severe preeclampsia and also 57.1-60% of those destined to have PIH or mild preeclampsia.
4-In primigravidae with positive protodiastolic notch or roll-over test, low dose aspirin (75 mg tablet/day) could significantly reduced the incidence of severe preeclampsia. Aspirin should be started early to maximize its benefits.