Low-dose Aspirin for all? – A case report identifying potential maternal side effects

Introduction Preeclampsia (PE) is one of the main reasons for maternal and fetal morbidity and mortality. Numerous studies have shown a significant reduction of developing PE when low-dose aspirin is taken in pregnancies at risk starting before 16 weeks of gestation (SSW). FMF London has established a standardized screening algorithm to identify women at risk. Still the question remains whether low-dose aspirin should be given to pregnant women with defined risk factors, just to those screened positive or even to all.

Case report A 40y IIIG IP was admitted at 22+6 SSW with syncope and severe anemia (Hb 77 g/l) due to gastrointestinal bleeding. The patient suffered from ulcerative colitis diagnosed several years ago treated with Mesalazine. In 2016 she developed preeclampsia with HELLP syndrome and partial placental abruption at 35 SSW. In the current pregnancy low-dose aspirin (100mg) was prescribed at 13 SSW. Aspirin was stopped immediately and the patient was given three infusion of red blood cell concentrate. Steroids were administered and the bleeding stopped 48 hours after the cessation of aspirin. The patient was discharged after 9 days.

Conclusion It has been shown that low-dose aspirin taken before 16 weeks of gestation is effective in preventing preeclampsia in a high-risk population. On the other hand exposure to low-dose aspirin in patients with a history of inflammatory bowel disease may result in life-threatening bleeding. Therefor the use of aspirin has to be discussed individually considering both the possible benefits and the adverse effect for mother and child.

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Publication History

Article published online:
07 October 2020