Page 174 - Hospital Authority Convention 2018

Masterclasses
HOSPITAL AUTHORITY CONVENTION 2018

M16.1 Reduction of Perinatal Morbidity and Mortality 14:30 Theatre 2

Screening and Prevention of Pre-eclamptic Toxaemia
Poon L
Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
There is now substantial evidence from the Aspirin for Evidence Based Preeclampsia Prevention (ASPRE) trial that the
rate of delivery with preterm-PE can be reduced by >60% by aspirin started at 11-14 weeks’ gestation in high-risk women.
The ASPRE trial was designed to test the hypothesis that aspirin at a dose of 150 mg per night from 11-14 until 36 weeks’
gestation, as compared with placebo, would result in halving the incidence of preterm-PE. In this multicentre, double-blind,
placebo-controlled trial, women with singleton pregnancies identified as being at high-risk of preterm-PE, by means of the
first-trimester combined test were randomised to receive aspirin (150 mg per night) vs. placebo from 11-14 until 36 weeks’
gestation. Preterm-PE occurred in 1.6% (13/798) participants in the aspirin group, as compared with 4.3% (35/822) in the
placebo group (odds ratio in the aspirin group, 0.38). However, there was no significant reduction in the rate of term-PE with
the use of aspirin prophylaxis (odds ratio in the aspirin group, 0.95).
In a secondary analysis of data from the ASPRE trial, the effect of prophylactic use of aspirin during pregnancy in women
at high-risk of PE on the length of stay in the neonatal intensive care unit (NICU) was evaluated. In the trial, 1,571 of 1,620
neonates were liveborn. The total length of stay in NICU was substantially longer in the placebo than aspirin group (1,696 vs.
531 days). This is a reflection of a significantly shorter mean length of stay in babies admitted to the NICU from the aspirin
than the placebo group (11.1 vs. 31.4 days; a reduction of 20.3 days). In the total population, including those that were not
admitted to the NICU, the mean length of stay was longer in the placebo than aspirin group (2.06 vs 0.66 days; reduction of 1.4
days). This corresponds to a reduction in length of stay of 68%.

Results from the ASPRE trial proves that effective screening for preterm-PE can be achieved with a combined test of maternal
factors and biomarkers at 11-13 weeks and that high-risk women can take aspirin at 150 mg per night from the first trimester
of pregnancy to significantly reduce their chances of developing preterm-PE, which is associated with a 70% reduction in the
length of stay in the NICU for the neonates.

M16.2 Reduction of Perinatal Morbidity and Mortality 14:30 Theatre 2

Prediction and Prevention of Preterm Labour
Law LW
Department of Obstetrics and Gynaecology, Prince of Wales Hospital, Hong Kong

Preterm birth (PTB) with delivery before 37 weeks of gestation is one of the major causes of perinatal morbidity and mortality.
Tuesday, 8 May 2018 Although the pathophysiology of spontaneous preterm labour or preterm prelabour rupture of membranes is complicated and
In Hong Kong, the incidence of preterm birth is about 7 %. Among these preterm births, 70% to 80% are spontaneous,
whereas the remaining 20% to 30% are iatrogenic either due to maternal or fetal health concerns.

diverse, multiple risks factors have been identified. Identification of patients at high risks of PTB before conception or early in
pregnancy provides an opportunity for interventions that may help to prevent this complication.

Among those risk factors, maternal reproductive history including previous preterm labour and sonographic measurement of
cervical length are two well recognised predictive factors. Various interventions like progesterone supplementation, cerclage
pessary or surgical cerclage may help to prevent or delay preterm delivery in some of these high-risk groups. Multiple
pregnancies are also more likely to have a preterm birth. Therefore, prevention and reduction of multiple pregnancies,
particularly high-order multiple pregnancies, can also reduce the risks of preterm birth. A healthy lifestyle including cessation
of smoking and drug misuse should always be stressed.

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