Secondary prevention and risk assessment of pre-eclampsia
THE CONTEXT
The passage describes preventive interventions in pregnancy and parameters used to assess pre-eclampsia risk.
Low-dose aspirin
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Low-dose aspirin, 75–150 mg daily, is begun early in pregnancy in potentially high-risk patients.
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Aspirin inhibits platelet cyclo-oxygenase and selectively reduces thromboxane A2 formation without interfering with prostacyclin generation.
Other preventive measures
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Heparin or low-molecular-weight heparin is useful in women with thrombophilia and high-risk pregnancy, but is not recommended routinely.
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Calcium supplementation at 2 g/day reduces the risk of gestational hypertension.
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Vitamins C and E, magnesium, zinc, fish oil and a low-salt diet have been tried but offer limited benefit.
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A balanced diet rich in protein may reduce risk. Sildenafil has limited value.
Uterine artery Doppler and risk scoring
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The illustrated second-trimester uterine artery Doppler patterns include normal diastolic flow and reduced end-diastolic velocity with a notch.
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The listed risk-scoring parameters are MAP, UtA-P, PLGF and first-trimester PAPP-A, with sPLGF and sFlt-1 in the second and third trimesters.
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The passage classifies a risk below 1 in 100 as low and above 1 in 100 as high. High-risk women are started on aspirin, and risk scoring guides allocation to level 1, 2 or 3 care.