Evaluation of the Effect of Low Dose Aspirin on Cervical Length as an Indicator of Preterm Labor in Nulliparous Women
الموضوعات :Maryam Gharehgozloei 1 , Majid Mirmohammadkhani 2 , Mojgan Rahmanian 3
1 - Abnormal Uterine Bleeding Research Center, Semnan University of Medical Sciences, Semnan, Iran
2 - Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
3 - Abnormal Uterine Bleeding Research Center, Semnan University of Medical Sciences, Semnan, Iran
الکلمات المفتاحية: Aspirin, Preterm Labor, Cervical Length,
ملخص المقالة :
Preterm labor is one of the most common midwifery problems in developing and even advanced countries imposing a huge cost on people and the health system. One of the most important causes of preterm labor is short cervical length. Periodic monitoring of cervical length is an important factor in predicting incidence of preterm labor. The purpose of this study was to determine the effect of low dose aspirin on cervical length in nulliparous women. In a double-blind randomized clinical trial, nulliparous pregnant women with gestational age of less than 13 weeks and 6 days were enrolled in the study and randomly divided into intervention and control groups. Demographic, clinical and Para clinical data were recorded. The intervention group received 80 mg daily aspirin, while the control group received placebo. Cervical length and maternal and fetal outcomes were recorded and analyzed. The results have shown a decrease in cervical length at 12, 18 and 30 weeks of gestation in the control group and an increase in the intervention group, indicating the effect of aspirin administration on prevention of preterm labor (P <0.05). Maternal complications were not significantly different between the two groups. Cervical length with cut-off point of 30 at 30 weeks’ gestation had a positive predictive value of 64% and a negative predictive value of 94% in predicting preterm labor. Our study has shown that low-dose aspirin administration may prevent cervical length reduction and preterm labor, although it has had no effect on reducing maternal complications such as preeclampsia, vaginal bleeding, low birth weight, and spontaneous abortion. Moreover, measurement of cervical length (with cut-off point of 30 mm) in the third trimester of pregnancy is a good indicator in predicting preterm labor.
1. Mathews T.J., MacDorman M.F., 2006. Infant mortality statistics from the 2003 period linked birth/infant death data set. National vital statistics reports : from the Centers for Disease Control and Prevention, National Center for Health Statistics. National Vital Statistics System. 54, 1-29.
2. Peltier M.R., Faux D.S., Hamblin S.D., Cooper C., Silver R.M., Esplin M.S., 2009. Effect of aspirin treatment on TNFalpha production by women with a history of preterm birth. Journal of reproductive immunology. 80, 109-114.
3. Martin J.A., Hamilton B.E., Sutton P.D., Ventura S.J., Mathews T.J., Kirmeyer S., Osterman M.J., 2010. Births: final data for 2007. National vital statistics reports: from the Centers for Disease Control and Prevention, National Center for Health Statistics. National Vital Statistics System. 58, 1-85.
4. Silver R.M., Ahrens K., Wong L.F., Perkins N.J., Galai N., Lesher L.L., Faraggi D., Wactawski-Wende J., Townsend J.M., Lynch A.M., Mumford S.L., Sjaarda L., Schisterman E.F., 2015. Low-dose aspirin and preterm birth: a randomized controlled trial. Obstetrics and gynecology. 125, 876-884.
5. Bujold E., Roberge S., Tapp S., Giguere Y., 2011. Opinion & hypothesis could early aspirin prophylaxis prevent against preterm birth? The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies. the International Society of Perinatal Obstet. 24, 966-967.
6. Noripour S., Molaei A., Bandari R., Emadi A , Far SM , Forozeshfard M., 2017. Comparison of the results of simultaneous surfactant administration and nasal continuous positive airway pressure (INSURE) and Non-administration of surfactant for the treatment of infants with respiratory distress syndrome. Journal of Comprehensive Pediatrics. 8(1), e37462.
7. Choi S.J., 2017. Use of progesterone supplement therapy for prevention of preterm birth: review of literatures. Obstetrics & Gynecology Science. 60, 405-420.
8. Lamont R.F., 2004. Bacterial vaginosis. In: Critchley H, Bennett P, ThorntonS, editors. Preterm Birth. London: RCOG Press, 163–180.
9. Petrou S., 2005. The economic consequences of preterm birth during the first 10 years of life. BJOG: an international journal of obstetrics and gynaecology. 112(Suppl 1), 10-5.
10. Goodnight W., 2016. Clinical Application of Progesterone for the Prevention of Preterm Birth, 2016. American journal of perinatology. 33, 253-257.
11. Jayedi A., Soltani S., Abdolshahi A., Shab-Bidar S., 2020. Healthy and Unhealthy Dietary Patterns and the Risk of Chronic Disease: An Umbrella Review of Meta-Analyses of Prospective Cohort Studies. British Journal of Nutrition. 1-12.
12. Jayedi A., Emadi A., Khan TA., Abdolshahi A., Shab-Bidar S., 2020. Dietary Fiber and Survival in Women with Breast Cancer: A Dose-Response Meta-Analysis of Prospective Cohort Studies. Nutrition and Cancer. 1-11.
13. Jaju P.B., Dhabadi V.B., 2011. Nifedipine versus ritodrine for suppression of preterm labor and analysis of side effects. Journal of obstetrics and gynaecology of India. 61, 534-537.
14. Moroz L.A., Brock C.O., Govindappagari S., Johnson D.L., Leopold B.H., Gyamfi-Bannerman C., 2017. Association between change in cervical length and spontaneous preterm birth in twin pregnancies. American journal of obstetrics and gynecology. 159, 1-7.
15. Nasr R., Hasanzadeh H., Khaleghian A., Moshtaghian A., Emadi A., Moshfegh S.H., 2018. Induction of apoptosis and inhibition of invasion in gastric cancer cells by titanium dioxide nanoparticles. Oman medical journal. 33(2), 111-117.
16. Iams J.D., 2003. Prediction and early detection of preterm labor. Obstetrics and gynecology. 101, 402-412.
17. Hernandez-Andrade E., Romero R., Ahn H., Hussein Y., Yeo L., Korzeniewski S.J., Chaiworapongsa T., Hassan S.S., 2012. Transabdominal evaluation of uterine cervical length during pregnancy fails to identify a substantial number of women with a short cervix. The journal of maternal-fetal & neonatal medicine. 25, 1682-1689.
18. Berghella V, Saccone G., 2019. Cervical assessment by ultrasound for preventing preterm delivery. Cochrane database of systematic reviews. (9).https://doi.org/10.1002/14651858.CD007235.pub4.
19. Romero R., Nicolaides K., Conde-Agudelo A., Tabor A., O'Brien J.M., Cetingoz E., Da Fonseca E., Creasy G.W., Klein K., Rode L., Soma-Pillay P., Fusey S., Cam C., Alfirevic Z., Hassan S.S., 2012. Vaginal progesterone in women with an asymptomatic sonographic short cervix in the midtrimester decreases preterm delivery and neonatal morbidity: a systematic review and metaanalysis of individual patient data. American journal of obstetrics and gynecology. 124,1-19.
20. Berghella V., Keeler S.M., To M.S., Althuisius S.M., Rust O.A., 2010. Effectiveness of cerclage according to severity of cervical length shortening: a meta-analysis. Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. 35, 468-473.
21. Berghella V., Odibo AO., To M.S., Rust O.A., Althuisius S.M., 2005. Cerclage for short cervix on ultrasonography: meta-analysis of trials using individual patient-level data. Obstetrics and gynecology.106, 181-189.
22. James A.H., Brancazio L.R., Price T., 2008. Aspirin and reproductive outcomes. Obstetrical & gynecological survey. 63, 49-57.
23. Askie L.M., Duley L., Henderson-Smart D.J., Stewart L.A., 2007. Antiplatelet agents for prevention of pre-eclampsia: a meta-analysis of individual patient data. Lancet (London, England). 369, 1791-1798.
24. Lambers M.J., Hoozemans D.A., Schats R., Homburg R., Lambalk C.B., Hompes P.G., 2009. Low-dose aspirin in non-tubal IVF patients with previous failed conception: a prospective randomized double-blind placebo-controlled trial. Fertility and sterility. 92, 923-929.
25. Duley L., Henderson-Smart D.J., Knight M., King J.F., 2007. Antiplatelet agents for preventing pre-eclampsia and its complications. The Cochrane database of systematic reviews. (4), 1-117.
26. Marret S., Marchand L., Kaminski M., Larroque B., Arnaud C., Truffert P., Thirez G., Fresson J., Roze J.C., Ancel P.Y., 2010. Prenatal low-dose aspirin and neurobehavioral outcomes of children born very preterm. Pediatrics. 125, 29-34.
27. Bujold E., Roberge S., Demers S., Nicolaides K.H., 2012. Aspirin administration for prevention of adverse pregnancy outcomes. Fetal and Maternal Medicine Review. 23, 187-200.
28. Gray P.H., 2014. In infants born extremely preterm, aspirin or NSAID use during pregnancy are associated with increased risk of quadriparetic cerebral palsy. Evidence-based nursing. 17, 16-17.
29. Abramovici A., Cantu J., Jenkins S.M., 2012. Tocolytic therapy for acute preterm labor. Obstetrics and gynecology clinics of North America. 39, 77-87.
30. Bujold E., Roberge S., Lacasse Y., Bureau M., Audibert F., Marcoux S., Forest J.C., Giguere Y., 2010. Prevention of preeclampsia and intrauterine growth restriction with aspirin started in early pregnancy: a meta-analysis. Obstetrics and gynecology.116, 402-414.
31. Roberge S., Villa P., Nicolaides K., Giguere Y., Vainio M., Bakthi A., Ebrashy A., Bujold E., 2012. Early administration of low-dose aspirin for the prevention of preterm and term preeclampsia: a systematic review and meta-analysis. Fetal diagnosis and therapy. 31, 141-146.
32. Melamed N., Pittini A., Hiersch L., Yogev Y., Korzeniewski S.S., Romero R., Barrett J., 2016. Serial cervical length determination in twin pregnancies reveals 4 distinct patterns with prognostic significance for preterm birth. American journal of obstetrics and gynecology. 476, 1-11.
33. Odibo A.O., Goetzinger K.R., Odibo L., Tuuli M.G., 2015. Early prediction and aspirin for prevention of pre-eclampsia (EPAPP) study: a randomized controlled trial. Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. 46, 414-418.
34. Benshalom-Tirosh N., Tirosh D., Aricha-Tamir B., Weintraub A.Y., Erez O., Mazor M., Hershkovitz R., 2015. The clinical utility of sonographic cervical length in the management of preterm parturition at 28-32 weeks of gestation. The journal of maternal-fetal & neonatal medicine. 28(16), 1929-1933.
35. Papastefanou I., Pilalis A., Eleftheriades M., Souka A.P., 2015. Prediction of Preterm Delivery by Late Cervical Length Measurement after 24 Weeks. Fetal diagnosis and therapy. 38, 200-204.
36. Ayala D.E., Ucieda R., Hermida R.C., 2013. Chronotherapy with low-dose aspirin for prevention of complications in pregnancy. Chronobiology international. 30, 260-279.
37. Yu C.K., Papageorghiou A.T., Parra M., Palma Dias R., Nicolaides K.H., 2003. Randomized controlled trial using low-dose aspirin in the prevention of pre-eclampsia in women with abnormal uterine artery Doppler at 23 weeks' gestation. Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. 22, 233-239.
38. Rotchell Y.E., Cruickshank J.K., Gay M.P., Griffiths J., Stewart A., Farrell B., Ayers S., Hennis A., Grant A., Duley L., Collins R., 1998. Barbados Low Dose Aspirin Study in Pregnancy (BLASP): a randomised trial for the prevention of pre-eclampsia and its complications. British journal of obstetrics and gynaecology. 105, 286-292.
