Preterm preeclampsia is a serious pregnancy complication affecting pregnant women before the completion of 37 weeks gestation. Severe preterm preeclampsia appears usually before 32 weeks gestation. This is a very dangerous pregnancy complication that is responsible for a significant number of maternal, fetal and neonatal deaths. Preterm preeclampsia afflicts 3-7% or all pregnancies worldwide and it is the leading cause of maternal death in many countries, including the US.
Preventing preeclampsia and more so, preterm preeclampsia, has always been one of the most important goals in obstetrical research. Over the last 35 years, tens of randomized clinical trials (RCTs) provided enough evidence to support the use of low dose aspirin. When aspirin is started at 11-14 weeks gestation, as much as 62% of cases of preeclampsia can be prevented.
It is not fully understood how aspirin prevents preeclampsia. One of the ways that is most likely to act is by its effect on the platelets and by restoring balance between the thromboxane that increases the risk for preeclampsia and prostacyclin that reduces the risk.
Severe preeclampsia is usually associated with severe placental insufficiency, growth restriction (IUGR), prematurity, and a number of other placental related complications, such as, cerebral palsy, and physical and neurodevelopmental delays. Aspirin acts as an anticoagulant and as an immune system modulator in addition to its effect on suppression of pro-inflammatory cytokines. Low molecular weight heparin (LMWH) like enoxaparin, has similar effects on the immune system and the coagulation system. Furthermore, LMWH has significant angiogenic effects and stimulates neovascularization and new placenta growth.
The combination of low dose aspirin (81 mg to 150 mg) and LMWH from the beginning of the pregnancy or as close as possible to the first trimester can eliminate severe preterm preeclampsia all together and reduce the incidence of all types of preeclampsia by 95%. At Kofinas Perinatal we pay extreme attention to placenta development from the earliest stages of pregnancy and with our protocols have been able to eliminate severe preterm preeclampsia and reduce overall preeclampsia by 95%.