From: Reducing stillbirths: prevention and management of medical disorders and infections during pregnancy
Source | Location and Type of Study | Intervention | Stillbirths/Perinatal Outcomes |
---|---|---|---|
Reviews and meta-analyses | |||
Askie et al. 2007 [50] | USA, Zimbabwe, Italy, Brazil, Australia, Jamaica, Spain, UK, South Africa, China, Barbados, Israel, Japan, France, Belgium, Finland. Meta-analysis (Lancet). 31 RCTs (N = 30 563 women) were included. | To assess the effectiveness and safety of anti-platelet drugs for prevention of pre-eclampsia and its consequences vs. placebo. | SBR+neonatal death before discharge (23 trials): RR = 0.91 (95% CI: 0.81–1.03) [NS] [484/15412 vs. 524/15260 in intervention vs. control groups, respectively.] |
Australia, Austria, Barbados, Brazil, Finland, France, Israel, Italy, Netherlands, Russia, South Africa, UK, USA, Jamaica, Zimbabwe, China, Spain, India, Belgium. Meta-analysis (Cochrane). 42 RCTs (N = 37,560 women) included. | To assess the effectiveness and safety of anti-platelet agents (intervention group) vs. placebo (controls) for women at risk of developing pre-eclampsia. | Fetal loss (miscarriage+SB): RR = 0.96 (95% CI: 0.78–1.18) [NS] [169/9109 vs. 172/8960 in intervention vs. control groups, respectively.] PMR: RR = 0.89 (95% CI: 0.74–1.08) [NS] [190/8294 vs. 212/8256 in intervention vs. control groups, respectively.] 2001 findings (30 RCTs): Fetal loss (miscarriage+SB): RR = 0.86 (95% CI: 0.75–0.98). | |
Intervention studies | |||
Beaufils et al. 1991 [191] | France. RCT. N = 323 women at 15–18 wks amenorrhea at 25 centres with prior history of FGR or placental abruption. | Compared impact of aspirin vs. placebo on birth weight, FGR, placental abruption, and stillbirth. | SBR: 1% vs. 5% in intervention vs. control groups, respectively. Mean birth weight difference: 225 g (95% CI: 129–321 g, P = 0.029) [mean birth weight 2751 (SD = 670) vs. 2526 (SD = 848) g in intervention vs. control groups, respectively.] FGR: 13% (N = 20) vs. 26% (N = 19); P < 0.02). Placental abruption: 5% vs. 8% in intervention vs. control groups, respectively. |
Tempfer et al. 2006 [192] | Austria. Prospective case-control study. N = 102 women, N = 50 intervention group, N = 52 controls, all with a history of idiopathic recurrent miscarriage, defined as ≥ 3 consecutive miscarriages < 20 wks gestation without associated anatomic, cytogenetic, hormonal, and infectious pathologies or anti-phospholipid syndrome. | To compare a combination treatment of prednisone (20 mg/d) and progesterone (20 mg/d) for the first 12 weeks of gestation, aspirin (100 mg/d) for 38 weeks of gestation, and folate (5 mg every second day) throughout their pregnancies (intervention group) with no treatment (controls). | Live birth rate: 77% (40/52) vs. 35% (18/52) in intervention vs. control groups, respectively (P = 0.04). |
Observational studies | |||
Backos et al. 1999 [193] | UK, tertiary referral clinic. Prospective observational study. N = 150 women with history of recurrent miscarriage associated with persistently positive tests for anti-phospholipid antibodies. | Assessed impact of administration of low dose aspirin and low dose heparin. | Live births: 71% (107/150, 71%). Miscarriage: 27% SBR: 1% NND: 1% Pre-term: 24% (N = 26) |
Deligiannidis et al. 2007 [66] | Greece. Prospective study (N = 52 women, N = 29 intervention, N = 23 controls who declined intervention). | Anti-thrombotic therapy (low-dose aspirin and low molecular weight heparin) vs. controls. | Fetal death rate (miscarriage+SB): OR = 0.10 (95% CI: 0.002–0.98, Fisher exact test, 0.04) [1/29 vs. 17/23 in intervention vs. control groups, respectively]. |
Leduc et al. 2007 [194] | Canada (hospital records). Retrospective cohort study. N = 110 pregnancies (N = 50 intervention, N = 60 controls) among women (N = 43) with ≥ 1 pregnancy complicated by severe early-onset pre-eclampsia, placental abruption, fetal growth restriction (FGR), or fetal death. | Anti-coagulant prophylaxis was administered using dalteparin in 13 pregnancies, ASA with dalteparin in 26, and ASA alone in 11. | SB: No deaths occurred. |