Comparative analysis of different regimens for the prevention of placenta-associated complications in high-risk women

Objective: To analyze the course and outcomes of pregnancy in patients with severe preeclampsia concurrent in some cases with a history of fetal growth restriction and/or Hemolysis, Elevated Liver enzymes and Low Platelets (HELLP) syndrome according to different regimens for the prevention of these complications (acetylsalicylic acid (ASA) or ASA and low-molecular-weight heparin (LMWH)) during subsequent pregnancy. Materials and methods: An investigation conducted in the V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology in 2016 and 2022 included 48 pregnant women with a family obstetric history (severe preeclampsia, HELLP syndrome, fetal growth restriction), who were divided into 2 groups: 1) 20 pregnant women who took only ASA for prophylactic purposes; 2) 28 pregnant women who were treated with ASA and LMWH. Clinical, laboratory, and instrumental examinations were made. Results: The incidence of preeclampsia in the ASA groups was 50%, that of fetal growth restriction was 30%; combination (ASA and LMWH) therapy caused a 1.75-fold decrease in the incidence of preeclampsia from 50 to 28.6% (p=0.113) and a 4.43-fold reduction in that of fetal growth restriction (p=0.045). The incidence of early-onset severe preeclampsia was slightly lower in Group 2; however, there were no statistically significant results. It was also noted that there was no case of recurrent antenatal fetal death in this pregnancy during anticoagulant therapy started no later than 16 weeks’ gestation in women with a history of antenatal fetal death. Conclusion: The investigation revealed a positive trend in reducing the incidence of early-onset severe preeclampsia and fetal growth restriction and showed the effectiveness of preventing antenatal fetal death with the combined prophylactic use of ASA and LMWH. The findings may suggest that it is expedient to add LMWH at a prophylactic dose to ASA in the first trimester of pregnancy. Clearly, further studies are needed to recruit more patients.

acetylsalicylic acid, low-molecular-weight heparin, preeclampsia, fetal growth restriction syndrome, HELLP syndrome