LOW DOSE ASPIRIN PROPHYLAXIS USE AMONG PRE-ECLAMPTIC/ECLAMPTIC WOMEN WITH HISTORY-BASED RISK FACTOR(S) IN A TERTIARY HOSPITAL IN GHANA

Abstract

Background

Pre-eclampsia/eclampsia remains a top cause of maternal morbidity and mortality as well as a major cause of perinatal morbidity and mortality at Komfo Anokye Teaching Hospital and the world over. Starting low dose aspirin before 16 weeks in high-risk women prevents preterm preeclampsia. Anecdotal evidence suggests that it is common to find patients admitted with preeclampsia/eclampsia with risk factors at the beginning of pregnancy who would have benefited from low dose aspirin but never received it. Objective This study assesses the use of prophylactic low dose aspirin among women admitted to Komfo Anokye Teaching Hospital with pre-eclampsia/eclampsia who had history-based risk factors in early pregnancy. Methods

This is a cross-sectional analytical study. Women admitted to the obstetric high dependency unit with preeclampsia/eclampsia were recruited consecutively till the sample size of 271 was attained. A structured questionnaire, antenatal care records, hospital in-patient records and discharge notes were used to obtain the relevant data which were analyzed using IBM SPSS version 26.0. Chi square was used to assess associations of adverse maternal and fetal/neonatal outcomes among women that received low dose aspirin compared to those that did not receive low dose aspirin. P-values less than 0.05 were considered statistically significant. Results

59% of the women with preeclampsia/eclampsia had the risk factors warranting prophylactic low dose aspirin in early pregnancy with only 26.9% of these high-risk women receiving prophylactic low dose aspirin. Low dose aspirin prophylaxis was significantly associated with estimated gestational age of pre-eclampsia/eclampsia diagnosis (p < 0.0001). Low dose aspirin prophylaxis was significantly associated with a reduction in the incidence of intra- uterine growth restriction (p = 0.008), intra-uterine fetal death/termination of pregnancy (p = 0.001), prematurity (p = 0.001), neonatal intensive care unit admission (p = 0.001), neonatal mortality (p = 0.023) as well as the composite adverse neonatal outcome (p = 0.001). Low

dose aspirin prophylaxis significantly reduced maternal organ dysfunction (P = 0.001) with no significant reductions observed for other maternal outcomes of caesarean section, eclampsia, CVA, maternal mortality as well as the composite adverse maternal outcomes.

Conclusion Whiles the risk factors for preeclampsia do exist in our women at booking, majority of these high-risk women are not receiving prophylactic low dose aspirin. Prophylactic low dose aspirin reduces the incidence of early onset preeclampsia with a reduction in adverse fetal outcomes but no reductions in adverse maternal outcomes except for maternal organ dysfunction.