Desfecho e profilaxia com AAS em gestantes com cálculo de risco para pré-eclâmpsia

Abstract

Preeclampsia (PE) is a multisystemic obstetric syndrome that occurs from the twentieth week of pregnancy. Characterized by hypertension and proteinuria, it affects the liver, kidneys, heart, and circulatory system and complicate with eclampsia and brain damage, increasing maternal and neonatal morbidity and mortality. Studies show that low-dose acetylsalicylic acid (ASA), started before 16 weeks of gestation, decreases the incidence of PE and early PE. The aim of this study was to screen pregnant women using the Fetal Medicine Foundation (FMF) PE risk calculation algorithm, guiding ASA prophylaxis in those classified as high risk for PE and evaluating gestational outcome. In this prospective, observational study, 134 pregnant women who underwent first-trimester morphological ultrasound with gestational age between 11+0 and 13+6 weeks at the Fetal Medicine outpatient clinic of the Santa Maria University Hospital participated. All of them answered a questionnaire to enter data into the algorithm, maternal mean arterial pressure was checked, and morphological ultrasound and transabdominal color DOPPLER were performed to measure the pulsatility index of uterine arteries. Biochemical parameters were not included. The pregnant women screened as high risk received guidance on the use of prophylaxis with ASA at a dose of 150 mg/day until 36+0 weeks of gestation. They were divided into groups: early PE: ≤ 34+0; intermediate PE: 34+1 to 36+6; late PE: ≥ 37+0 weeks of gestation. In the study, 53.7% of pregnant women were classified as low risk and of these, 77.78% had no PE and when it occurred, most were late PE. Removing the influence of ASA, the FMF algorithm showed 76% accuracy, 58% specificity, 82% sensitivity, 87% positive predictive value, and 48% negative predictive value. The prescribed doses of ASA were 50, 81, 100 and 150 mg/day at night, and when comparing the most used (100 and 150 mg) there was no significant difference (p=0.5) among them in preventing PE. Of the pregnant women who adhered to prophylaxis, 70.21% had no PE, 21.28% had late PE and 2.12% had early PE, and were 5.3 times more likely to not develop PE than those who did not adhere. Of those who did not adhere, 69.23% had PE, even if late, and were 7.43 times more likely to have Late PE than no PE and 430.36% more likely to have PE than those who adhered to ASA. For those who adhered to ASA, the chance of Late PE is 900% greater than Early PE and 233% greater than Intermediate PE and for those who did not adhere to ASA is 132% chance of having PE. AAS reduced the incidence of PE by 56.97%. The algorithm was found to be an excellent method for screening for PE in the first trimester of pregnancy. Maternal and neonatal complications were related to PE, but not to ASA use.