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Aspirin for preventing and treating pre-eclampsia

BMJ 1999; 318 doi: (Published 20 March 1999) Cite this as: BMJ 1999;318:751

Large trials continue to show no benefit

  1. Lelia Duley, Obstetric epidemiologist
  1. Magpie Trial Coordinating Centre, Institute of Health Sciences, Oxford OX3 7LF

    Pre-eclampsia is a multisystem disorder usually associated with raised blood pressure and proteinuria. A relatively common complication of the second half of pregnancy, it affects 2-8% of pregnancies.1 Although outcome is often good, pre-eclampsia remains a major cause of morbidity and mortality for both woman and child. For example, the woman may develop renal or hepatic failure or disseminated intravascular coagulation or have a cerebrovascular haemorrhage. The baby may have intrauterine growth restriction, suffer the consequences of prematurity, or die in utero. The causes of pre-eclampsia remain obscure, but women with the condition produce excess thromboxane, and thus aspirin has long been tried for both prevention and treatment. Early trials were promising, but more recent ones have shown little benefit.

    Although the causes of pre-eclampsia are unknown, it is primarily a placental disorder.2 During implantation, deficient trophoblast invasion of the maternal spiral arteries leads to underperfusion of the uteroplacental circulation and placental ischaemia. The resulting placental damage is thought to be responsible for the release of, as yet unknown, factors into the maternal circulation, which then alter endothelial cell function and cause widespread circulatory …

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