WS12‐02Systematic screening with a uterine Doppler in low‐risk pregnant women followed by low‐dose aspirin in cases with abnormal results: results of the two French multicenter randomised controlled trial

Abstract

ObjectivesTwo large multicenter randomised trials were performed in France to assess whether systematic screening with an artery uteroplacental Doppler (AUD) in low‐risk pregnant women followed by the prescription of low‐dose aspirin in cases with abnormal results reduced the incidence of intrauterine growth restriction (IUGR) and of preeclampsia.Study design and populationThe first trial ‘Seine Saint‐Denis’ (SSD) trial included 3317 low‐risk pregnant women (multi and primigravidae) in 17 French maternity Hospitals and the second ‘Erasme’ trial included 1869 primigravidae in 12 centres. In the Doppler group, the AUD was performed between 20 and 24 weeks, and women with abnormal results received 100 mg of aspirin daily until the 35th week.ResultsIn the Doppler group, 232 patients (15.7%) had an abnormal result in the SSD trial and 20% in the ERASME trial. The predictive value of the AUD was comparable to that reported in the studies of low‐risk populations, but with a low sensitivity. Finally, IUGR, whether defined by the third or tenth percentile, and preeclampsia did not differ significantly between the treatment groups in both trials.ConclusionsThere is no proof justifying the recommendation of a systematic AUD in a low‐risk population, even if abnormal results are followed by aspirin treatment and increase in prenatal surveillance. Future studies must assess predictive tests that can be performed early in pregnancy and can identify populations at very high risk of preeclampsia and IUGR. Only when all of these conditions are fulfilled can aspirin prove its efficacy.