Indications+for+Aspirin+Prophylaxis

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** CCRMC OBGYN **** Prenatal Guideline ** Consultation available 24 hours per day from OB on-call at 925-370-5608 or via page/amion, via inbasket to OB dept member or by calling Perinatologist at 510-444-0790 during the day and 510-204-1572 after hours. Consultation appointments or transfer of care to more experienced prenatal clinician available at major clinics sites—see consultation guidelines for more information.

** Criteria for Aspirin Prophylaxis in Pregnancy ** In large met analysis aspirin prophylaxis from 12-16 weeks in pregnancies at high risk for preeclampsia, risk of preeclampsia decreased by 24%, preterm birth due to preeclampsia by 14%, IUGR by 20%. Only low dose aspirin 81 mg (or 75mg) once daily is appropriate. At this time the risk of low dose ASA in pregnant is thought to be negligible and there is no demonstrated increased risk of abruption, postpartum hemorrhage, fetal harm, intracranial bleeding, congenital anomalies. Updated based on ACOG Practice Advisory July 11, 2016 found at: @http://m.acog.org/About-ACOG/News-Room/Practice-Advisories/Practice-Advisory-Low-Dose-Aspirin-and-Prevention-of-Preeclampsia-Updated-Recommendations?IsMobileSet=true ACOG recommends using the USPTF guidelines:


 * History of preeclampsia, especially when accompanied by and adverse outcome
 * Multifetal gestation
 * Chronic Hypertension --> BP __>__ 140/90 or taking antihypertensive medication
 * Diabetes Type 1 or Type 2
 * Renal Disease
 * Autoimmune disease (SLE, antiphospholipid syndrome)

At CCRMC/UBCP Maternal-Fetal Medicine also recommend ASA prophylaxis for:
 * Prior documented or convincing history of SGA baby
 * Prior unexplained fetal demise in the second or third trimester


 * __Timing of Prophylaxis__**


 * Benefit shown if started between 12-16 weeks gestation. Unclear benefit if started later than 16 weeks EGA. ACOG suggests starting up to 28 weeks gestation if not started earlier as recommended.
 * OK to start earlier in first trimester no concern for ectopic
 * Normally continue until delivery. Consider stopping near delivery if at otherwise high risk for blood loss, e.g. placenta previa.