ISSN:
1471-0528
Source:
Blackwell Publishing Journal Backfiles 1879-2005
Topics:
Medicine
Notes:
Objective To assess the effectiveness of a pre-eclampsia prevention strategy based on routine uterine artery Doppler flow velocity waveform examination during the second trimester of pregnancy, followed by a prescription for 100 mg aspirin in the case of abnormal Doppler findings.Design Multicentre randomised controlled trial.Setting Eleven centres in the north of France and one in Belgium.Population One thousand and eight hundred and fifty-three nulliparous women recruited between 14 and 20 weeks of gestation.Methods Randomisation either to undergo a uterine Doppler examination between 22 and 24 week of gestation or to take a placebo. Women with abnormal Doppler waveforms received 100 mg of aspirin daily from Doppler examination through 36 weeks.Main outcome measures Pre-eclampsia was defined as hypertension (≥ 140 and/or 90 mmHg) associated with proteinuria (≥ 0.5 g/L).Results One thousand two hundred and fifty-three women (67%) were randomised into the systematic Doppler group and 617 (33%) into the placebo group. Of the 1175 patients in the Doppler group who underwent this examination, 239 (20.3%) had abnormal uterine artery Doppler and received a prescription for aspirin. Despite the aspirin prescription, the frequency of pre-eclampsia did not differ between the systematic Doppler group and the placebo group (28 of 1237 [2.3%] vs 9 of 616 [1.5%]; RR = 1.55, 95% CI 0.7–3.3). Furthermore, the groups did not differ in the frequency of children who were very small for their gestational age (≤3rd centile) or for perinatal deaths. Compared with patients with normal Doppler findings, those with abnormal Doppler were at high risk of pre-eclampsia (RR = 5.5, 95% CI 2.5–12.2) and of giving birth to a small-for-gestational-age child (RR = 3.6, 95% CI 1.6–8.1).Conclusion Despite its sensitivity in screening for pre-eclampsia, routine uterine Doppler in the second trimester cannot be recommended for nulliparous patients.
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1046/j.1471-0528.2003.t01-1-02097.x
