Abstract
Objective: The aim of this study was to compare a low-dose aspirin treatment on placental and perinatal effects in the patients with poor obstetric history such as preeclampsia, intrauterine growth retardation (IUGR) in previous pregnancy. Study design: This retrospective study of 86 pregnant women was conducted between April 2002 and June 2005. In this study period 364 placentas were examined and the patients with poor obstetric history such as IUGR and preeclampsia were selected. Then the patients were assigned to three groups; group 1 (n = 30) was composed of women with no risk in previous pregnancy; group 2 (n = 27) was composed of patients with poor obstetric history (e.g., preeclampsia, IUGR) who were treated with aspirin and patients in group 3 (n = 29) had poor obstetric history without any treatment (patients who were started to follow-up after 14 weeks of gestation). Patients in group 2 were treated with a low-dose aspirin (80 mg/day) as soon as a urinary pregnancy test was positive. Treatment was usually stopped at 34 completed weeks of gestation. On histopathologic examination of the placenta, uteroplacental vascular pathologic features and secondary villous damage (such as fibrinoid necrosis of desidual vessels, villous infarct, severely increased villous fibrosis, severely increased syncytiotrophoblast knotting, obliteration of the vessel lumen, severely increased villous hypervascularity) and also lesions involving coagulation (such as excessive perivillous fibrin deposition, multiple occlusive thrombi in uteroplacental vessels, avascular villi ) were examined. Results: There were no significant differences between the groups with respect to maternal age, body mass index at the first trimester and delivery. Also there were no significant differences among groups with respect to placental weight, fetal height, weight, gestational week, umbilical artery pH, pO2, pCO2 and base excess status. The incidences of preeclampsia were 3.3, 7.4, 6.8% and the incidences of IUGR were 6.7, 11.1, 6.8% in the groups, respectively (P > 0.05 for both). Although the percentages of all pathologic findings were higher in groups 2 and 3, these differences were not statistically important. Conclusion: When low-dose aspirin is taken, starting at the beginning of pregnancy in patients with poor obstetric history, there are still high frequencies of uteroplacental vascular and related villous lesions persisted on placental bed. Also it has no beneficial effects on perinatal outcomes in these patients.
Similar content being viewed by others
References
Coomarasamy A, Papaioannou S, Gee H, Khan K (1988) Geographic variation in the incidence of hypertension in pregnancy. World Health Organization International Collaborative Study of Hypertensive Disorders of pregnancy. Am J Obstet Gynecol 158:80–83
Ghidini A, Salafia C, Pezzullo J (1997) Placental vascular lesions and likelihood of diagnosis of preeclampsia. Obstet Gynecol 90:542–545
Robertson WB, Brosens L, Dixon HG (1967) The pathological response of the vessels of the placental bed to hypertensive pregnancy. J Pathol Bacteriol 93:581–592
Redman CWG (1991) Preeclampsia and the placenta. Placenta 12:301–308
Liu HS, Chu TY, Yu MH, Chang YK, Ko CS, Chao CF (1998) Tromboxane and prostacyclin in maternal and fetal circulation in preeclampsia. Int J Gynaecol Obstet 63:1–6
Walsh SW (1985) Preeclampsia: an imbalance in placental prostacyclin and tromboxane production. Am J Obstet Gynecol 152:335–340
Vainio M, Rýutta A, Koivisto AM, Maennpaa (2004) Prostacyclin, Tromboxane A2 and the effect of low dose ASA in pregnancies at high risk for hypertensive disorders. Acta Obstet Gynecol 83:1119–1123
Masotti G, Galanti G, Poggesi L, Abbate R, Neri-Serneri GG (1979) Differential inhibition of prestacyclin production and platelet aggregation by aspirin. Lancet 2:213–217
Sibai BM, Mercer B, Sarinoglu C (1991) Severe preeclampsia in the second trimester; recurrence risk and long tem prognosis. Am J Obstet Gynecol 165:1408–1412
Campbell DM, MacGillivray I, Carr-Hill R (1985) Preeclampsia in the second pregnancy. Br J Obstet Gynecol 92:131–140
Patrignani P, Filabozzi P, Patrono C (1982) Selective cumulative inhibition of platelets tromboxane production by low dose aspirin. J Clin Invest 69:1366–1372
Forbes JF, Smalls MJ (1983) A comparative analysis of birthweight for gestational age standards. Br J Obstet Gynecol 99:297–303
Fox H (1997) Pathology of the placenta. W.B. Saunders, London
Salafia CM, Weigl CA, Silberman L (1989) The prevalence and distribution of acute placental inflammation in uncomplicated term pregnancies. Obstet Gynecol 73:383–389
Salafia CM, Pezzullo JC, Lopez-Zeno JA, Sherer DM, Whittington SS, MiniorVK, Vintzileos AM (1995) Histologic evidence of old intrauterine bleeding is more frequent in prematurity. Am J Obstet Gynecol 73:1065–1070
Khong TY, Chambers HM (1992) Alternative methods of sampling placentas for the assessment of uteroplacental vasculature. J Clin Pathol 45:925–927
Ghidini A, Pezzulo C, Sylvestre G, Lembet A, Salafia M (2001) Antenatal corticosteroids and placental histology in preterm birth. Placenta 22:412–417
Khong TY, Pearce JM, Robertson WB (1987) Acute atherosis in preeclampsia: maternal determinants and fetal outcome in the presence of the lesion. Am J Obstet Gynecol 157:360–363
Salafia CM, Thorp J, Starzyk KA (2000) Placental pathology in spontaneous prematurity. In: Kingdom J, Jauniaux E, O’Brien S (eds) The placenta: basic science and clinical practice. RCOG Press, London
Redline RM (1999) Disorders of the placental parenchyma. In: Lewis Perrin (ed) Pathology of the placenta. Churchill Livinstone, London
Altshuler G (1984) Chorangiosis: an important placental sign of neonatal morbidity and mortality. Arch Pathol Lab Med 108:71–74
Stevens NG, Sander CH (1984) Placental hemorrhagic endovasculitis: risk factors and impact on pregnancy outcome. Int J Gynecol Obstet 22:393–397
Salafia C, Pezzullo C, López-Zeno J, Simmens S, Minior V, Vintzileos AM (1995) Placental pathologic features of preterm preeclampsia. Am J Obstet Gynecol 173:1097–1105
Cusick W, Salafia CM, Ernst L, Rodis JF, Campbell WA, Vintzileos AM (1995) Low dose aspirin therapy and placental pathology in women with poor prior pregnancy outcomes. Am J Reprod Immunol 34:141–147
Merviel P, Carbillon L, Challier J, Rabreau M, Beaufils M, Uzan S (2004) Pathophysiology of preeclampsia: links with implantation disorders. Eur J Obstet Gynecol 115:134–147
Walker JJ (2000) Preeclampsia. Lancet 356:1260–1265
Caritis S, Sibai B, Hauth J (1998) Low dose aspirin to prevent preeclampsia in women at high risk. N Engl J Med 338:701–705
Knight M, Duley L, Henderson-Smart DJ, King JF (2000) Antiplatelet agents for preventing and treating preeclampsia. Cochrane Database Syst Rev 2:CD000492
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Tarim, E., Bal, N., Kilicdag, E. et al. Effects of aspirin on placenta and perinatal outcomes in patients with poor obstetric history. Arch Gynecol Obstet 274, 209–214 (2006). https://doi.org/10.1007/s00404-006-0162-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00404-006-0162-y