Aspirin and Preeclampsia Prevention (Gestosis)

Taking low doses of Aspirin can help future mothers at risk for Preeclampsia (Gestosis).

When during pregnancy occurs a blood pressure rise associated with Proteinuria (urine protein loss) after

preeclampsia

Blood pressure measurements during pregnancy are crucial steps for prevention and early detection of PreEclampsia (also improperly called Gestosis)

the 20th gestational week we talk about Preeclampsia or Eclampsia (severe form). This syndrome in past years used to be called Gestosis or Pregnancy Toxicosis it is identified by the acronym EPH (Edema, Proteinuria, Hypertension) and is a serious danger to both mother and fetus. It is estimated an overall incidence (all clinical forms) between 5 and 14% of all pregnancies and that as many as 15% of all premature births is dependent on this condition.

The Preeclampsia causes are not yet fully known and the topic is a scientific research subject. It is thought that bring to a reduced uterine arteries blood flow that lead to an increase in resistance and therefore blood pressure resistance but not all specialists agree.

Identified risk factors are:

  • A pre-existing hypertension;
  • Conception Age lesser than 19 and greater than 40;
  • Diabetes;
  • Kidney Diseases;
  • Obesity;
  • Multiple pregnancies;
  • Auto-immune Diseases;
  • Urinary infections;
  • Pre-Eclampsia in a previous pregnancy;
  • Mother or sister who had Pre-Eclampsia;
  • First pregnancy or long time since the previous pregnancy;
  • Progressive slight increase in blood pressure during gestation last quarter.

The symptoms of Preeclampsia are not typical and may sometimes be completely absent. Much attention should be paid to:

  • Fluid retention (face, legs, hands swelling)
  • Sudden increase in body weight (an increase of 2 kg in 1-2 days be alarmed);
  • Headache;
  • Vomit;
  • Dizziness;
  • Diuresis reduction (less urinating);
  • Upper abdomen pain;
  • Visual disturbances.

The diagnosis is made by detection of at least two or three measurements spaced 4-6 hours of blood pressure measurement (BP) greater than 140/90 and the presence of protein (Proteinuria) in urine.

The tests that your doctor will check as well as a quantitative assessment of Proteinuria are generally blood count, protein electrophoresis (blood protein), liver enzymes, renal function and coagulation. Even the fetus will be subject to more stringent controls as second level obstetric ultrasound, cardiotocography and biophysical profile.

The subsequent clinical decisions depend on the seriousness (clinical condition of mother and fetus) and on the gestational age sometimes requiring immediate hospitalization and the birth fulfillment. Particularly dangerous are early onset forms (<34 weeks) because they often lead to miscarriage.

Preeclampsia and Eclampsia can also be a serious threat to both maternal and fetal life: in fact, sometimes, high pressure can cause neurological damage (cerebral hemorrhage, seizures, coma) and involve other vital organs such as Kidneys, the Heart and Lungs. In Pre-Eclampsia (many identified it as Gestosis or Pregnancy Toxemia) placental exchange of nutrients progressively or sometimes dramatically decrease, compromising fetus growth and vitality.

HELPP syndrome (characterized by hemolysis, elevated liver enzymes, low platelets), although considered by some independent clinical entity, may in fact constitute a rare but fearsome complication.

Placenta detachment (placental abruption) is another dreadful complication with immediate risk of fetal and maternal death.

In recent years, much attention has been paid to early detection and prevention.

Clinical testing of the PA assiduity and uterine examination at least once in a month in low risk pregnancies allow a sufficiently good early identification. With this strategy, some physicians associate some biochemical tests in the first quarter and an evaluation of uterine artery flowmetry in the second quarter.

By contrast, it is useful the prevention or the correction of possible risk factors, but exists a possibility of a prevention when risk factors are not modifiable?

Aspirin is a real hope for prevention.  After years of uncertainty, it seems to have finally shown that small doses of this medicine (between 50 and 160 mg / day) reduces the risk of Pre-Eclampsia by 24%. In fact, according to a statement from the U.S. Preventive Services Task Force published in “Annals of Internal Medicine”, taking Aspirin after the third month of pregnancy would not only reduce the incidence of Pre-Eclampsia but also some of its complications such as miscarriage (14 %) and fetal hypo-growth (20%).

A controlled use of low-dose of Aspirin in pregnant women at high risk of eclampsia is really very useful and it would seem therefore not matched by any short-term damage.

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Filiberto Di Prospero
Medical Doctor, Consultant in Gynecology and Obstetrics, Endocrinology and Metabolism. Director of Gynecologic Endocrinology Unit at Civitanova Marche General Hospital (Italy). Private clinics in Civitanova Marche, Rome and Milan.

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