{"id":14148,"date":"2023-02-23T12:10:55","date_gmt":"2023-02-23T12:10:55","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/?page_id=14148"},"modified":"2024-12-27T13:50:43","modified_gmt":"2024-12-27T13:50:43","slug":"aspirin-antenatal-prophylaxis","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/pregnancy\/aspirin-antenatal-prophylaxis\/","title":{"rendered":"Aspirin &#8211; antenatal prophylaxis"},"content":{"rendered":"\n<p><strong>Information<\/strong><\/p>\n\n\n\n<p>Low dose aspirin has been shown to reduce the risk of pre-eclampsia, fetal growth restriction (FGR) and spontaneous preterm labour in at risk pregnancies.&nbsp;&nbsp;<\/p>\n\n\n\n<p>Pre-eclampsia affects approximately 1% of pregnancies and increases the risk of maternal and perinatal mortality and morbidity. FGR affects up to 10% of pregnancies and is associated with serious adverse outcomes including stillbirth. Preterm delivery affects up to 8% of pregnancies and is also associated with perinatal morbidity and mortality. Some preterm birth is related to poor placentation which is the same issue that arises with pre-eclampsia and FGR.&nbsp;&nbsp;<\/p>\n\n\n\n<p>Aspirin is a non steroidal anti-inflammatory drug with antiplatelet properties. It is a cyclooxygenase inhibitor of COX1 and 2 and interferes with prostaglandin synthesis promoting vasodilatation and reducing platelet aggregation.&nbsp;&nbsp;&nbsp;<\/p>\n\n\n\n<p><strong>M.A. &amp; K.D. 23-02-23<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><strong>Women should be risk assessed by their community midwife at the booking visit (8-11 weeks), referred to\/discussed with the locality obstetric consultant and have aspirin started by 12 weeks gestation if possible (at the latest 20 weeks).<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>One high risk factor:<\/strong> Prescribe 150mg aspirin nocte from 12 weeks until delivery, or as soon as a risk factor is identified<em>&nbsp;<\/em>\n\n\n<ul class=\"wp-block-list\">\n<li>Hypertensive disease during a previous pregnancy&nbsp;<\/li>\n\n\n\n<li><span style=\"color: initial\">Chronic kidney disease<\/span><\/li>\n\n\n\n<li><span style=\"color: initial\">Chronic hypertension&nbsp;<\/span><\/li>\n\n\n\n<li><span style=\"color: initial\">Autoimmune disease such as SLE or antiphospholipid syndrome&nbsp;<\/span><\/li>\n\n\n\n<li><span style=\"color: initial\">Type\u202f1 or type\u202f2 diabetes&nbsp;<\/span>\n<ul class=\"wp-block-list\">\n<li><span style=\"color: initial\">At risk of preterm birth:<\/span><\/li>\n\n\n\n<li>previous mid-trimester loss<\/li>\n\n\n\n<li><span style=\"color: initial\">spontaneous preterm delivery &lt;34 weeks<\/span><\/li>\n\n\n\n<li>spontaneous rupture of the membranes &lt;34 weeks&nbsp;<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>PAPPA &lt;0.4 MOM&nbsp;(this is measured as part of the combined first trimester screening for trisomies 21, 18 and 13, results available around 14-15 weeks gestation)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<p><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>2+ moderate risk factors:<\/strong> Prescribe 150mg aspirin nocte from 12 weeks until delivery, or as soon as a risk factor is identified<em>&nbsp;&nbsp;<\/em><ul><li>First pregnancy&nbsp;<\/li><\/ul>\n<ul class=\"wp-block-list\">\n<li>Age 40\u202fyears or older<\/li>\n\n\n\n<li>Pregnancy interval of more than 10\u202fyears&nbsp;<\/li>\n\n\n\n<li>Body mass index (BMI) of 35\u202fkg\/m2 or more at first visit&nbsp;<\/li>\n\n\n\n<li>Family history of pre-eclampsia<\/li>\n\n\n\n<li>Multi-fetal pregnancy&nbsp;<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p>Ensure that women at increased risk are appropriately offered and prescribed low dose aspirin antenatally to reduce the risk of pre-eclampsia, IUGR and preterm birth.&nbsp;&nbsp;<\/p>\n\n\n\n<p>NB. Side effects of aspirin include: GI irritation, tinnitus, bronchospasm, hypersensitivity, severe cutaneous adverse reactions. &nbsp;<\/p>\n\n\n\n<p>Contraindications:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>A history of true hypersensitivity to aspirin, salicylates or another nonsteroidal anti-inflammatory drug (NSAID).(Symptoms of hypersensitivity to aspirin or salicylates include bronchospasm, urticaria, angioedema, and rhinitis. These can occur in isolation or in combination and can lead to severe or life-threatening reactions)<\/li>\n\n\n\n<li><span style=\"color: initial\">Active pathological bleeding, such as peptic ulcer or intracranial haemorrhage<\/span><\/li>\n\n\n\n<li><span style=\"color: initial\">Severe cardiac failure<\/span><\/li>\n\n\n\n<li><span style=\"color: initial\">Severe hepatic impairment<\/span><\/li>\n\n\n\n<li><span style=\"color: initial\">Severe renal impairment<\/span><\/li>\n\n\n\n<li>Haemophilia or another haemorrhagic disorder (including thrombocytopenia)<\/li>\n<\/ul>\n\n\n\n<p><\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p>NICE Hypertension in Pregnancy June 2019 <a rel=\"noreferrer noopener\" href=\"https:\/\/www.nice.org.uk\/guidance\/ng133\" target=\"_blank\">https:\/\/www.nice.org.uk\/guidance\/ng133<\/a>&nbsp;<\/p>\n\n\n\n<p>The impact of low-dose aspirin on adverse perinatal outcomes: a meta-analysis and meta-regression analysis.&nbsp;<\/p>\n\n\n\n<p>Ultrasound Obstet Gynecol Sep 19 Turner et al.&nbsp;&nbsp;<\/p>\n\n\n\n<p><sup>Ayala DE, <\/sup><sup>Ucieda<\/sup><sup> R, Hermida RC. Chronotherapy with low-dose aspirin for prevention of complications in pregnancy. <\/sup><sup>Chronobiol<\/sup><sup> Int 2013;30:260-79.<\/sup>&nbsp;<\/p>\n\n\n\n<p><sup>Caron N, Rivard GE, Michon N, et al. Low-dose ASA response using the PFA- 100 in women with high-risk pregnancy. J <\/sup><sup>Obstet<\/sup><sup> <\/sup><sup>Gynaecol<\/sup><sup> Can 2009;31:1022-7.<\/sup>&nbsp;&nbsp;<\/p>\n\n\n\n<p>Am J Obstet Gynaecol 2018 Oct;219(4):399.e1-399.e6. doi: 10.1016\/j.ajog.2018.06.011. Epub 2018 Jun 18 Andikopolou et al&nbsp;<\/p>\n\n\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Information Low dose aspirin has been shown to reduce the risk of pre-eclampsia, fetal growth restriction (FGR) and spontaneous preterm labour in at risk pregnancies.&nbsp;&nbsp; Pre-eclampsia affects approximately 1% of pregnancies and increases the risk of maternal and perinatal mortality and morbidity. FGR affects up to 10% of pregnancies and is associated with serious adverse<\/p>\n","protected":false},"author":6,"featured_media":0,"parent":4337,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[894],"class_list":["post-14148","page","type-page","status-publish","hentry","category-https-apps-nhslothian-scot-refhelp-aspirin-antenatal-prophylaxis"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"heatherlevy","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/heatherlevy\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/pregnancy\/https-apps-nhslothian-scot-refhelp-aspirin-antenatal-prophylaxis\/\" rel=\"tag\">Aspirin - antenatal prophylaxis<\/a>","rttpg_excerpt":"Information Low dose aspirin has been shown to reduce the risk of pre-eclampsia, fetal growth restriction (FGR) and spontaneous preterm labour in at risk pregnancies.&nbsp;&nbsp; Pre-eclampsia affects approximately 1% of pregnancies and increases the risk of maternal and perinatal mortality and morbidity. FGR affects up to 10% of pregnancies and is associated with serious adverse","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/14148","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=14148"}],"version-history":[{"count":5,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/14148\/revisions"}],"predecessor-version":[{"id":22234,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/14148\/revisions\/22234"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4337"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=14148"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=14148"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}