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Angiotensin sensitivity predicts aspirin benefit in placental insufficiency
Objective:
To determine whether the beneficial effects of aspirin in the treatment of Doppler umbilical placental insufficiency correlate with the maternal pressor response to angiotensin infusion.
Design:
An open trial.
Setting:
A tertiary referral obstetric service.
Patients:
Women identified at between 25 and 36 weeks of pregnancy with an elevated umbilical artery Doppler systolic/diastolic (S/D) ratio and a positive pressor response to angiotensin infusion.
Intervention:
Low dose aspirin (100mg/day) treatment of mothers.
Main Outcome Measure:
Fetal and placental size at delivery in relation to subsequent maternal angiotensin responsiveness.
Results:
Women who converted from a positive angiotensin pressor response to angiotensin refractoriness after aspirin administration had larger infants and placentas compared with those whose response remained positive.
Conclusion:
Angiotensin sensitivity predicts women with umbilical Doppler detected placental insufficiency responding to aspirin therapy. Loss of the normal refractory response in pregnancy may be a consequence of vascular pathology in the placenta.