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Abstract
Discussion Forum (0)
Introduction: Preeclampsia, a leading cause of morbidity and mortality, complicates 2-8% of pregnancies. Prior to the 2019 ACOG Preeclampsia Practice Bulletin, we found that administering aspirin to patients at risk for early onset preeclampsia (EOPE) resulted in a fewer than expected patients developing EOPE (6 vs. 12).
Methods: IRB approved, retrospective (2014-2020) review of pregnant patients undergoing first trimester screening for EOPE risk (PlGF, PAPP-A, AFP, UtAD-PI and MAP) at a single MFM office. Singleton patients were screened at 11-13 weeks. Inclusion criteria: nulliparity, personal or family history of preeclampsia, chronic hypertension, renal disease, lupus. High-EOPE-risk (greater than 1/50) patients were placed on low dose ASA prior to 14 weeks and were closely monitored. The dosage of aspirin increased from 81 mg to 162 mg after 873 patients were treated.
Results: Based on updated testing of 1,555 at-risk patients, the expected number of EOPE was 17.5. 172 patients screened at high-risk with 2 terminations and 170 live births. Six patients developed EOPE (less than 34 weeks) including 4 of 172 screen-positive (2.3%, 95% CI 0.6%-5.8%) and 2 of the 1,383 screen-negative patients (0.1%, 95%CI; 0.01%-0.5%). Four of six high-risk EOPE patients received 81 mg of aspirin.
Conclusion/Implications: Universal screening with aspirin treatment still resulted in less EOPE (6 vs 17.5). Early aspirin treatment (prior to 14 weeks with 162 mg ) may reduce EOPE and associated perinatal morbidity/mortality. Further study is warranted.
Methods: IRB approved, retrospective (2014-2020) review of pregnant patients undergoing first trimester screening for EOPE risk (PlGF, PAPP-A, AFP, UtAD-PI and MAP) at a single MFM office. Singleton patients were screened at 11-13 weeks. Inclusion criteria: nulliparity, personal or family history of preeclampsia, chronic hypertension, renal disease, lupus. High-EOPE-risk (greater than 1/50) patients were placed on low dose ASA prior to 14 weeks and were closely monitored. The dosage of aspirin increased from 81 mg to 162 mg after 873 patients were treated.
Results: Based on updated testing of 1,555 at-risk patients, the expected number of EOPE was 17.5. 172 patients screened at high-risk with 2 terminations and 170 live births. Six patients developed EOPE (less than 34 weeks) including 4 of 172 screen-positive (2.3%, 95% CI 0.6%-5.8%) and 2 of the 1,383 screen-negative patients (0.1%, 95%CI; 0.01%-0.5%). Four of six high-risk EOPE patients received 81 mg of aspirin.
Conclusion/Implications: Universal screening with aspirin treatment still resulted in less EOPE (6 vs 17.5). Early aspirin treatment (prior to 14 weeks with 162 mg ) may reduce EOPE and associated perinatal morbidity/mortality. Further study is warranted.
Introduction: Preeclampsia, a leading cause of morbidity and mortality, complicates 2-8% of pregnancies. Prior to the 2019 ACOG Preeclampsia Practice Bulletin, we found that administering aspirin to patients at risk for early onset preeclampsia (EOPE) resulted in a fewer than expected patients developing EOPE (6 vs. 12).
Methods: IRB approved, retrospective (2014-2020) review of pregnant patients undergoing first trimester screening for EOPE risk (PlGF, PAPP-A, AFP, UtAD-PI and MAP) at a single MFM office. Singleton patients were screened at 11-13 weeks. Inclusion criteria: nulliparity, personal or family history of preeclampsia, chronic hypertension, renal disease, lupus. High-EOPE-risk (greater than 1/50) patients were placed on low dose ASA prior to 14 weeks and were closely monitored. The dosage of aspirin increased from 81 mg to 162 mg after 873 patients were treated.
Results: Based on updated testing of 1,555 at-risk patients, the expected number of EOPE was 17.5. 172 patients screened at high-risk with 2 terminations and 170 live births. Six patients developed EOPE (less than 34 weeks) including 4 of 172 screen-positive (2.3%, 95% CI 0.6%-5.8%) and 2 of the 1,383 screen-negative patients (0.1%, 95%CI; 0.01%-0.5%). Four of six high-risk EOPE patients received 81 mg of aspirin.
Conclusion/Implications: Universal screening with aspirin treatment still resulted in less EOPE (6 vs 17.5). Early aspirin treatment (prior to 14 weeks with 162 mg ) may reduce EOPE and associated perinatal morbidity/mortality. Further study is warranted.
Methods: IRB approved, retrospective (2014-2020) review of pregnant patients undergoing first trimester screening for EOPE risk (PlGF, PAPP-A, AFP, UtAD-PI and MAP) at a single MFM office. Singleton patients were screened at 11-13 weeks. Inclusion criteria: nulliparity, personal or family history of preeclampsia, chronic hypertension, renal disease, lupus. High-EOPE-risk (greater than 1/50) patients were placed on low dose ASA prior to 14 weeks and were closely monitored. The dosage of aspirin increased from 81 mg to 162 mg after 873 patients were treated.
Results: Based on updated testing of 1,555 at-risk patients, the expected number of EOPE was 17.5. 172 patients screened at high-risk with 2 terminations and 170 live births. Six patients developed EOPE (less than 34 weeks) including 4 of 172 screen-positive (2.3%, 95% CI 0.6%-5.8%) and 2 of the 1,383 screen-negative patients (0.1%, 95%CI; 0.01%-0.5%). Four of six high-risk EOPE patients received 81 mg of aspirin.
Conclusion/Implications: Universal screening with aspirin treatment still resulted in less EOPE (6 vs 17.5). Early aspirin treatment (prior to 14 weeks with 162 mg ) may reduce EOPE and associated perinatal morbidity/mortality. Further study is warranted.
Experience with Early Onset Preeclampsia Screening and Prevention in a Private Practice: 2020 Update.
Dr. Sheri Hamersley
Abstract
Discussion Forum (0)
Introduction: Preeclampsia, a leading cause of morbidity and mortality, complicates 2-8% of pregnancies. Prior to the 2019 ACOG Preeclampsia Practice Bulletin, we found that administering aspirin to patients at risk for early onset preeclampsia (EOPE) resulted in a fewer than expected patients developing EOPE (6 vs. 12).
Methods: IRB approved, retrospective (2014-2020) review of pregnant patients undergoing first trimester screening for EOPE risk (PlGF, PAPP-A, AFP, UtAD-PI and MAP) at a single MFM office. Singleton patients were screened at 11-13 weeks. Inclusion criteria: nulliparity, personal or family history of preeclampsia, chronic hypertension, renal disease, lupus. High-EOPE-risk (greater than 1/50) patients were placed on low dose ASA prior to 14 weeks and were closely monitored. The dosage of aspirin increased from 81 mg to 162 mg after 873 patients were treated.
Results: Based on updated testing of 1,555 at-risk patients, the expected number of EOPE was 17.5. 172 patients screened at high-risk with 2 terminations and 170 live births. Six patients developed EOPE (less than 34 weeks) including 4 of 172 screen-positive (2.3%, 95% CI 0.6%-5.8%) and 2 of the 1,383 screen-negative patients (0.1%, 95%CI; 0.01%-0.5%). Four of six high-risk EOPE patients received 81 mg of aspirin.
Conclusion/Implications: Universal screening with aspirin treatment still resulted in less EOPE (6 vs 17.5). Early aspirin treatment (prior to 14 weeks with 162 mg ) may reduce EOPE and associated perinatal morbidity/mortality. Further study is warranted.
Methods: IRB approved, retrospective (2014-2020) review of pregnant patients undergoing first trimester screening for EOPE risk (PlGF, PAPP-A, AFP, UtAD-PI and MAP) at a single MFM office. Singleton patients were screened at 11-13 weeks. Inclusion criteria: nulliparity, personal or family history of preeclampsia, chronic hypertension, renal disease, lupus. High-EOPE-risk (greater than 1/50) patients were placed on low dose ASA prior to 14 weeks and were closely monitored. The dosage of aspirin increased from 81 mg to 162 mg after 873 patients were treated.
Results: Based on updated testing of 1,555 at-risk patients, the expected number of EOPE was 17.5. 172 patients screened at high-risk with 2 terminations and 170 live births. Six patients developed EOPE (less than 34 weeks) including 4 of 172 screen-positive (2.3%, 95% CI 0.6%-5.8%) and 2 of the 1,383 screen-negative patients (0.1%, 95%CI; 0.01%-0.5%). Four of six high-risk EOPE patients received 81 mg of aspirin.
Conclusion/Implications: Universal screening with aspirin treatment still resulted in less EOPE (6 vs 17.5). Early aspirin treatment (prior to 14 weeks with 162 mg ) may reduce EOPE and associated perinatal morbidity/mortality. Further study is warranted.
Introduction: Preeclampsia, a leading cause of morbidity and mortality, complicates 2-8% of pregnancies. Prior to the 2019 ACOG Preeclampsia Practice Bulletin, we found that administering aspirin to patients at risk for early onset preeclampsia (EOPE) resulted in a fewer than expected patients developing EOPE (6 vs. 12).
Methods: IRB approved, retrospective (2014-2020) review of pregnant patients undergoing first trimester screening for EOPE risk (PlGF, PAPP-A, AFP, UtAD-PI and MAP) at a single MFM office. Singleton patients were screened at 11-13 weeks. Inclusion criteria: nulliparity, personal or family history of preeclampsia, chronic hypertension, renal disease, lupus. High-EOPE-risk (greater than 1/50) patients were placed on low dose ASA prior to 14 weeks and were closely monitored. The dosage of aspirin increased from 81 mg to 162 mg after 873 patients were treated.
Results: Based on updated testing of 1,555 at-risk patients, the expected number of EOPE was 17.5. 172 patients screened at high-risk with 2 terminations and 170 live births. Six patients developed EOPE (less than 34 weeks) including 4 of 172 screen-positive (2.3%, 95% CI 0.6%-5.8%) and 2 of the 1,383 screen-negative patients (0.1%, 95%CI; 0.01%-0.5%). Four of six high-risk EOPE patients received 81 mg of aspirin.
Conclusion/Implications: Universal screening with aspirin treatment still resulted in less EOPE (6 vs 17.5). Early aspirin treatment (prior to 14 weeks with 162 mg ) may reduce EOPE and associated perinatal morbidity/mortality. Further study is warranted.
Methods: IRB approved, retrospective (2014-2020) review of pregnant patients undergoing first trimester screening for EOPE risk (PlGF, PAPP-A, AFP, UtAD-PI and MAP) at a single MFM office. Singleton patients were screened at 11-13 weeks. Inclusion criteria: nulliparity, personal or family history of preeclampsia, chronic hypertension, renal disease, lupus. High-EOPE-risk (greater than 1/50) patients were placed on low dose ASA prior to 14 weeks and were closely monitored. The dosage of aspirin increased from 81 mg to 162 mg after 873 patients were treated.
Results: Based on updated testing of 1,555 at-risk patients, the expected number of EOPE was 17.5. 172 patients screened at high-risk with 2 terminations and 170 live births. Six patients developed EOPE (less than 34 weeks) including 4 of 172 screen-positive (2.3%, 95% CI 0.6%-5.8%) and 2 of the 1,383 screen-negative patients (0.1%, 95%CI; 0.01%-0.5%). Four of six high-risk EOPE patients received 81 mg of aspirin.
Conclusion/Implications: Universal screening with aspirin treatment still resulted in less EOPE (6 vs 17.5). Early aspirin treatment (prior to 14 weeks with 162 mg ) may reduce EOPE and associated perinatal morbidity/mortality. Further study is warranted.
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