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A Novel Approach to the Management of Pregnancies Complicated by Uteroplacental Insufficiency and Previous Stillbirth
Author(s) -
Oyelese K. O.,
Black R. S.,
Lees C. C.,
Campbell S.
Publication year - 1998
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/j.1479-828x.1998.tb03094.x
Subject(s) - medicine , placental insufficiency , aspirin , fetus , pregnancy , intensive care medicine , obstetrics , placenta , genetics , biology
EDITORIAL COMMENT: These interesting case reports present apparently favourable results of an uncontrolled experiment in the treatment of suspected fetal compromise. Women with a history of severe fetal growth retardation leading to fetal death in utero in whom no underlying cause (diabetes, renal disease, antiphospholipid syndrome) is found present a difficult management problem in future pregnancies. There is a clear risk of recurrence but there is no clearly proven effective method of prevention or treatment. In the past 40 years there have been many other methods of treating fetal growth retardation andplacental insufficiency, ranging from the introduction of intraamniotic amino acids and maternal intravenous dextrose infusions, to abdominal decompression, beta‐sympathomimetics, supplemental oxygen, dipyridamole, heparin and aspirin. Some of these methods carry risks and in the absence of a specific aetiology for the problem none of them has been shown effective in appropriately conducted trials. The use of trans dermal glyceryl trinitrate (GTN) for suspected fetal compromise has the advantages of ease of use and apparent safety, given the long experience with this drug. As the authors point out there is also theoretical and experimental justification of its use to improve Uteroplacental perfusion. However, these 2 cases cannot be considered reliable evidence of the use of GTN in clinical practice but may point the way for further research. Summary: To our knowledge, this is the first time that a combination of aspirin and glyceryl trinitrate (GTN) has been used in the prophylaxis of preeclampsia and fetal growth retardation, and their use associated with not only Doppler screening of the uterine arteries but also regular Doppler follow‐up of the fetal arterial and venous circulation. Whilst future trials are needed to prove whether screening, prophylaxis and Doppler management are individually beneficial, we propose that this combination of management strategies contributed to a good outcome in the cases described. Furthermore, randomized trials are required to determine the safety and efficacy of prophylactic low‐dose aspirin combined with GTN treatment in pregnancies affected by an impaired Uteroplacental circulation.