Recurrent Pregnancy Loss and Adverse Natal Outcomes by Rohilla Minakshi;

Author:Rohilla, Minakshi;
Language: eng
Format: epub
Publisher: Taylor & Francis Group
Published: 2020-02-24T00:00:00+00:00

Antepartum management

In a patient with a previous history of preeclampsia, early booking is advisable.

Early first-trimester ultrasound must be done for accurate assessment of gestational age. The frequency of further prenatal visits must be determined as per previous pregnancy outcomes. The woman with previous early-onset preeclampsia or the one resulting in preterm delivery must have earlier and more frequent health checkup visits. The woman should be informed about the signs and symptoms of preeclampsia and its prodromal features. Therefore, risk stratification can be done based on previous gestation.

Baseline laboratory investigations like complete blood count, renal function tests, metabolic profile, and urinalysis should be done at the first trimester. In women with previous early-onset preeclampsia, renal ultrasound can be considered, and thrombophilia screening is routinely done by some clinics.

It has been studied that systemic prostacyclin-thromboxane balance is altered in preeclampsia [13]. Low-dose aspirin (60–80 mg daily dose) is started in the late first trimester if preeclampsia in previous pregnancy led to the delivery of a preterm infant (less than 34 0/7 weeks) or if the woman had recurrent preeclampsia in more than one pregnancy [14,15]. The use of low-dose aspirin was studied in a meta-analysis of 59 studies comprising 37,000 women, and this indicated its potential benefit in high-risk women for reducing preeclampsia incidence and its adverse perinatal outcomes [16].

In the second trimester, reinforce information about signs and symptoms of preeclampsia, which may be supplemented by printed handouts. Instructions must be given to report if symptoms like severe headache, visual disturbances, nausea and vomiting, right upper quadrant or epigastrium discomfort and pain, or decreased fetal movements occur. Blood pressure should be checked at every prenatal visit, and the patient should also be advised to maintain home blood pressure records. The patient should be monitored for signs of preeclampsia at every visit.

Hospital admission is advocated for preeclampsia with severe features, severe fetal growth restriction, and recurrent preeclampsia for frequent maternal and fetal surveillance.

The frequency of both maternal and fetal surveillance must be increased in the last trimester as indicated. Daily assessment of maternal symptoms and fetal movement should be done by the patient. Since there is a known correlation between fetal growth restriction and preeclampsia, laboratory parameters, serial ultrasonography for fetal growth restriction and amniotic fluid assessment, umbilical artery Doppler, biophysical profile, and nonstress test must be done as indicated [17].

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