Abstract:
:Preeclampsia is defined as hypertension arising after 20 weeks of gestational age with proteinuria or other signs of end-organ damage and is an important cause of maternal and perinatal morbidity and mortality, particularly when of early onset. Although a significant amount of research has been dedicated in identifying preventive measures for preeclampsia, the incidence of the condition has been relatively unchanged in the last decades. This could be attributed to the fact that the underlying pathophysiology of preeclampsia is not entirely understood. There is increasing evidence suggesting that suboptimal trophoblastic invasion leads to an imbalance of angiogenic and antiangiogenic proteins, ultimately causing widespread inflammation and endothelial damage, increased platelet aggregation, and thrombotic events with placental infarcts. Aspirin at doses below 300 mg selectively and irreversibly inactivates the cyclooxygenase-1 enzyme, suppressing the production of prostaglandins and thromboxane and inhibiting inflammation and platelet aggregation. Such an effect has led to the hypothesis that aspirin could be useful for preventing preeclampsia. The first possible link between the use of aspirin and the prevention of preeclampsia was suggested by a case report published in 1978, followed by the first randomized controlled trial published in 1985. Since then, numerous randomized trials have been published, reporting the safety of the use of aspirin in pregnancy and the inconsistent effects of aspirin on the rates of preeclampsia. These inconsistencies, however, can be largely explained by a high degree of heterogeneity regarding the selection of trial participants, baseline risk of the included women, dosage of aspirin, gestational age of prophylaxis initiation, and preeclampsia definition. An individual patient data meta-analysis has indicated a modest 10% reduction in preeclampsia rates with the use of aspirin, but later meta-analyses of aggregate data have revealed a dose-response effect of aspirin on preeclampsia rates, which is maximized when the medication is initiated before 16 weeks of gestational age. Recently, the Aspirin for Evidence-Based Preeclampsia Prevention trial has revealed that aspirin at a daily dosage of 150 mg, initiated before 16 weeks of gestational age, and given at night to a high-risk population, identified by a combined first trimester screening test, reduces the incidence of preterm preeclampsia by 62%. A secondary analysis of the Aspirin for Evidence-Based Preeclampsia Prevention trial data also indicated a reduction in the length of stay in the neonatal intensive care unit by 68% compared with placebo, mainly because of a reduction in births before 32 weeks of gestational age with preeclampsia. The beneficial effect of aspirin has been found to be similar in subgroups according to different maternal characteristics, except for the presence of chronic hypertension, where no beneficial effect is evident. In addition, the effect size of aspirin has been found to be more pronounced in women with good compliance to treatment. In general, randomized trials are underpowered to investigate the treatment effect of aspirin on the rates of other placental-associated adverse outcomes such as fetal growth restriction and stillbirth. This article summarizes the evidence around aspirin for the prevention of preeclampsia and its complications.
journal_name
Am J Obstet Gynecoljournal_title
American journal of obstetrics and gynecologyauthors
Rolnik DL,Nicolaides KH,Poon LCdoi
10.1016/j.ajog.2020.08.045subject
Has Abstractpub_date
2020-08-21 00:00:00eissn
0002-9378issn
1097-6868pii
S0002-9378(20)30873-5pub_type
杂志文章,评审abstract::The known effect of progesterone on carbohydrate metabolism prompted a study of some of the hepatic "lipogenic" and "gluconeogenic" enzymes in rats treated with progesterone. Several enzymes providing lipid precursors (phosphofructokinase, malic enzyme, glucose-6-phosphate dehydrogenase, and citrate cleavage enzyme) s...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(77)90732-3
更新日期:1977-09-15 00:00:00
abstract:OBJECTIVE:Our aim was to compare the effects of transdermal versus oral estrogens on vascular resistance index, mean arterial pressure, serum lipid concentrations, norepinephrine, and left ventricular structure. STUDY DESIGN:Ten postmenopausal women received transdermal estradiol (0.05 mg/d) plus cyclic oral progester...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1067/mob.2001.112104
更新日期:2001-04-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to establish normal ranges for human epididymis protein 4 (HE4) serum levels in healthy women. STUDY DESIGN:HE4 levels were measured in healthy women and analyzed by age, menopausal status, and pregnancy status. Upper 95th percentiles were determined for normal ranges. RESULTS:...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,meta分析
doi:10.1016/j.ajog.2011.12.028
更新日期:2012-04-01 00:00:00
abstract::There are two major approaches to the prophylaxis for adhesions: chemical methods (e.g., dextran) and barrier methods. Theoretically, dextran prevents the formation of adhesions by a surface-coating or hydroflotation effect, whereas the barrier methods either prevent the formation of or mask adhesions by covering and ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(82)90018-7
更新日期:1982-08-01 00:00:00
abstract::Immunoreactive endorphin peptides (ir EP) and prolactin (PRL) were measured by radioimmunoassay in venous blood from the umbilical cord of 86 neonates, 23 postpartum mothers, and 40 randomly selected blood bank donor control subjects. We also assayed these hormones in serosanguineous placental tissue fluid following d...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(81)90103-4
更新日期:1981-05-15 00:00:00
abstract::In this study the immediate neonatal acid-base status, obtained via a double-clamped segment of umbilical cord, in 75 term, singleton vaginal deliveries was compared to electronic fetal heart rate recordings and Apgar scores. Of 75 neonates, 59 had 1-minute Apgar scores greater than or equal to 7 and 52 had an initial...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(86)90717-9
更新日期:1986-06-01 00:00:00
abstract:OBJECTIVE:A controversy exists regarding the time to monitor blood glucose in the diabetic pregnancy (60 or 120 minutes after meals). Using a novel approach that provides continuous measurement of blood glucose, we sought to determine postprandial glucose profile in the diabetic pregnancy. STUDY DESIGN:Subjects were c...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2004.01.055
更新日期:2004-08-01 00:00:00
abstract::This letter was written in response to the article by P.G. Brooks et al ( 113: 104, 1972) in which the use of the peritoneoscope for removal of extruded intrauterine contraceptive devices (IUCD) with fluoroscopy to aid localization was recommended. In recent experiences of the authors of this letter and of R.R. MacD...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(72)90884-8
更新日期:1972-12-15 00:00:00
abstract:OBJECTIVE:Our purpose was to assess the impact of glucocorticoid administration on the rate of regional anesthesia in women with hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. STUDY DESIGN:Maternal records of pregnancies with HELLP syndrome managed between April 1994 and December 1999 were...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1067/mob.2002.121074
更新日期:2002-03-01 00:00:00
abstract::Immunoglobulins G, M, and A were found in varying concentrations in four different human fetal anatomic compartments of 17 fetuses in the absence of apparent infection. The highest levels were noted in the thoracic cavity. ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(88)80146-7
更新日期:1988-10-01 00:00:00
abstract::The term microinvasive carcinoma is inappropriate when applied to all vulvar cancers less than or equal to 5 mm thick because approximately 50% of vulvar carcinomas are no thicker than 5 mm and 20% of those superficial tumors metastasize to the lymph nodes. The significant predictors of groin node metastases in patien...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(87)90132-3
更新日期:1987-05-01 00:00:00
abstract:OBJECTIVE:Our purpose was to review the findings of a Gynecologic Endoscopic Review Committee established to monitor and review operative endoscopic procedures performed by the staff at a large private hospital, Swedish Hospital Medical Center, in Seattle. STUDY DESIGN:Hospital charts of patients undergoing the endosc...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1994-06-01 00:00:00
abstract::Effective communication is a hallmark of safe patient care. Challenges to effective interprofessional communication in maternity care include differing professional perspectives on clinical management, steep hierarchies, and lack of administrative support for change. We review principles of high reliability as they ap...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1016/j.ajog.2011.04.021
更新日期:2011-08-01 00:00:00
abstract::Colposacropexy procedures restore anatomically correct apical vaginal support on the levator plate at the ischial spine level. Venous hemorrhage resulting from laceration of presacral veins during suture fixation is the major hazard of this procedure. Titanium orthopedic bone anchor fixation minimizes this risk throug...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(97)70361-2
更新日期:1997-06-01 00:00:00
abstract::Fetal gender was prospectively determined by ultrasonography in 115 patients with singleton pregnancies between 16 and 20 weeks of gestation. Gender determination was performed as a part of the sonographic examination preceding genetic amniocentesis, and the results were compared to the amniotic fluid fetal karyotype ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(87)90055-x
更新日期:1987-03-01 00:00:00
abstract:OBJECTIVE:The objective of the study was to establish the risk of fetal death in early-onset growth-restricted fetuses with absent or reversed end-diastolic velocities in the umbilical artery or ductus venosus. DATA SOURCES:A systematic search was performed to identify relevant studies published in English, Spanish, F...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,meta分析
doi:10.1016/j.ajog.2017.11.566
更新日期:2018-02-01 00:00:00
abstract:OBJECTIVE:Our purpose was to test the hypothesis that severe placental insufficiency leads to reductions in fetal urine production and amniotic fluid volume in late-gestation fetal sheep. STUDY DESIGN:At 0.85 of gestation, chronically catheterized fetal sheep with ligated urachus were either embolized for 5 days by re...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1067/mob.2002.122291
更新日期:2002-05-01 00:00:00
abstract:OBJECTIVE:This study was undertaken to determine whether the presence of a dilated internal os (funneling or beaking) alters the outcome of patients with a short cervix documented by transvaginal ultrasound in the second trimester. STUDY DESIGN:Between January 1998 and May 2004, all singleton pregnancies with a short ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2005.01.076
更新日期:2005-04-01 00:00:00
abstract::Descriptive teratology has developed several fundamental precepts, two of which can now be challenged on the basis of experimental evidence. The first is that prior to implantation the developing embryo is not susceptible to survivable defects from chemical injury. The second is that developmental defects cannot be du...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1016/s0002-9378(87)80198-9
更新日期:1987-08-01 00:00:00
abstract::Pregnancy and peripartum/perinatal periods are characterized by significant biologic as well as psychosocial processes and changes that influence the 2 individuals at focus (mother and fetus), as well as their interactions with the immediate environment. Multiple intertwined pathologic pregnancy processes (hormonal, b...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1016/j.ajog.2005.02.103
更新日期:2005-10-01 00:00:00
abstract:OBJECTIVES:We sought to investigate the fetal hemodynamic response to the acute stress of invasive procedures. STUDY DESIGN:The middle cerebral artery pulsatility index was measured by Doppler ultrasonography before and after 136 invasive procedures (fetal blood sampling, transfusion, shunt insertion, tissue biopsy, a...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(99)70340-6
更新日期:1999-10-01 00:00:00
abstract::There is little insight into the pathogenesis of most of the dermatoses specifically associated with pregnancy. We evaluated the hormonal profile and the autoimmune background in 11 pregnant women with pruritic urticarial papules and plaques of pregnancy. No statistically significant difference was found between the s...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(88)90168-8
更新日期:1988-02-01 00:00:00
abstract::A subset of women with a high rate of fetal wastage is identifiable among those with serologic but not necessarily clinical evidence of connective tissue disease. The presence of lupus anticoagulant in the plasma of a pregnant woman serves as a marker for a high rate of fetal wastage and risk of thrombosis. Lupus anti...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1016/s0002-9378(85)80124-1
更新日期:1985-10-01 00:00:00
abstract::An hCG-like material has been extracted from human sperm. These experiments were designed to characterize this material. Sperms of 10 volunteers were separated from seminal fluid, washed in PBS three times, and resuspended in 0.5 ml of the same buffer. Samples were pooled; cells were disrupted by sonication and extrac...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(79)90733-6
更新日期:1979-12-15 00:00:00
abstract:OBJECTIVE:The objective of the study was to assess the adherence to hormonal contraception (pill, patch, ring, or injectable) among women veterans and examine the relationships between race/ethnicity and the months of contraceptive supply dispensed with contraceptive adherence. STUDY DESIGN:We conducted a retrospectiv...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2013.03.024
更新日期:2013-08-01 00:00:00
abstract:OBJECTIVE:Our purpose was to identify the age-related increased risks of the elderly gravida by clarifying the effects of age and parity, their combination, and their interaction. STUDY DESIGN:We studied 9556 singleton pregnancies in women aged 20 to 29 years or > or = 35 years delivered over an 8-year period. Data we...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(95)91409-9
更新日期:1995-06-01 00:00:00
abstract::A prospective study of carbohydrate metabolism was done with 56 "normal" women who were 4 to 11 weeks post partum. Each had a 3 hour oral glucose tolerance test performed before and after 6 months of using an intrauterine contraceptive device (IUCD). The results showed only slight changes in blood glucose and plasma ...
journal_title:American journal of obstetrics and gynecology
pub_type: 临床试验,杂志文章
doi:10.1016/0002-9378(75)90850-9
更新日期:1975-12-15 00:00:00
abstract:OBJECTIVE:This study was undertaken to clone and express a recombinant human zona pellucida protein 3 and to characterize its biologic activities as a sperm ligand and an inducer of the acrosome reaction. STUDY DESIGN:Human ovarian teratocarcinoma (PA-1) cells were transfected with an expression vector containing huma...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1067/mob.2001.113849
更新日期:2001-04-01 00:00:00
abstract::Plasma triglyceride concentration and blood oxygen tension were measured in samples obtained by cordocentesis from 35 small- and 54 appropriate-for-gestational-age fetuses at 18 to 36 weeks' gestation. In the appropriate-for-gestational-age fetuses there was an exponential decrease in plasma triglycerides with gestati...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(90)90391-j
更新日期:1990-02-01 00:00:00
abstract:OBJECTIVE:The study aims to investigate the prevalence of maternity blues and examine the risk factors involved in a group of Nigerian postpartum women. STUDY DESIGN:Five hundred and two postpartum women who had a normal vaginal delivery in 5 health centers in Ilesa Township were assessed with the Maternity Blues Scal...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,多中心研究
doi:10.1016/j.ajog.2005.02.085
更新日期:2005-10-01 00:00:00