1

Integrative Review of the Literature

Angela Jackson

Bon Secours Memorial College of Nursing

NUR 4322 Nursing Research

Dr. Holowaychuk, EdD RN

November 20, 2021

“I pledge…”
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Abstract

Purpose: This integrative review aims to examine the effect of low-dose aspirin in preventing

preeclampsia and reducing the number of preterm births. Background: Preterm spontaneous

births continue to increase worldwide. One significant health condition linked to spontaneous

preterm births is preeclampsia, which is linked to linked to acute or chronic hypertension that

occurs around 20 weeks gestation. Women diagnosed with preeclampsia usually have a blood

pressure over 140/90 mmHg. Design and Search Method: The research design is an

integrative review based on two quantitative articles selected from online research databases,

Google Scholar, PubMed and EBSCO, and Ovid. Results and Findings: Low-dose aspirin can

significantly lower blood pressure in pregnant women, which can prevent preeclampsia and

premature births. Early intervention of low-dose aspirin in high-risk preterm women has

extended gestation from 36 to 37 weeks. Implications for Practice: The results of this review

indicate a positive response in nulliparous women and high-risk preterm women treated with

low-dose aspirin alone or in combination with other preterm risk therapies. Recommendations

for Future Research: Additional research should be conducted on non-nulliparous women and

women, not at risk for preterm births.

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Integrative Review of the Literature

The purpose of this integrative review is to explore the effect of low-dose aspirin in

reducing the number of premature births for pregnant women diagnosed with preeclampsia.

Premature birth is an ongoing health concern and is classified as any birth before 37-weeks

gestation. Approximately 15 million pregnancies worldwide each year have been premature

births, with a majority births being spontaneous preterm births (Ibrahim, Mohamed, Gadallah,

Mahmoud, & Shora, 2019). Spontaneous preterm births are any births that are less than or

equal to 20-weeks gestation (Ali, et al., 2020). More studies are being conducted to narrow

down the cause of the increasing number of premature births and spontaneous births; one

major cause has been linked to preeclampsia.

Preeclampsia is a health condition linked to human pregnancy, and incidents of

preeclampsia appear to be significantly higher in women with a lack of healthcare, pre-existing

health conditions such as diabetes, chronic hypertension, and multifetal gestations. Women are

usually diagnosed with preeclampsia during their twentieth week of gestation. The

classifications of preeclampsia are a systolic blood pressure higher than 140 mmHg and a

diastolic blood pressure higher than 90 mmHg with proteinuria. Therefore, starting medical

interventions before 20-weeks to help reduce the risk of hypertension may help to manage or

prevent hypertension and preeclampsia. In addition, the possibility of finding a cost-effective

intervention would help reduce healthcare costs and allow for the intervention to be available for

lower-income patients. This integrative literature review aims to discuss and analyze research

studies related to the PICO question: For pregnant women diagnosed with preeclampsia(P)

does the use of low-dose aspirin (I) compared to women not treated with low-dose aspirin (C)

reduce the risk of premature births (O)?

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Design and Search Methods

The research design is an integrative review. Research for these articles was conducted

using search engines like Google Scholar, PubMed and EBSCO and Ovid. Search terms

included, ‘Low-dose aspirin’, ‘preeclampsia’, ‘preterm birth’, and ‘folic acid’. The search yield 5

Google Scholar articles, 1 PubMed article, 31 Ovid articles, and 6 articles from EBSCO which

indicated a lack of literature on the topic. To provide information in agreement with the issue, the

search was limited to peer reviewed qualitative and quantitative medical journal articles,

published in English, and written between 2016 and 2021.

The articles had to relate to the researcher’s PICO question, “For pregnant women

diagnosed with preeclampsia(P) does the use of low-dose aspirin (I) compared to women not

treated with low-dose aspirin (C) reduce the risk of premature births (O)?” The articles were

screened based on the following inclusion criteria: pregnant women, preeclampsia diagnosis,

low-dose aspirin treatment, and preterm birth prevention. The research articles were screened

based on inclusion criteria and PICO question significance. Articles that did not meet criteria

were excluded from the review. The screening process produced three quantitative research

articles about preeclampsia treatment with low-dose aspirin (Hoffman et al., 2020; Ibrahim et al.,

2019; Ali, et al., 2020).

Findings and Results

The findings and results of the three reviewed studies showed a positive effect of

utilizing low-dose aspirin as an intervention to prevent preeclampsia related premature births as

indicated by the clinical measure outcomes (Hoffman et al., 2020; Ibrahim et al., 2019); and

one quantitative article (Ali, et al., 2020). A synopsis of the compiled research articles is

presented in Appendix I. The researcher framed the review according to the following

categories: low-dose aspirin for the prevention of preeclampsia and to prevent spontaneous

preterm births.
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Low-dose aspirin to prevent preeclampsia

There was a consensus among the three studies that the intervention of low-dose aspirin

may help prevent preeclampsia and spontaneous premature births. (Hoffman et al., 2020;

Ibrahim et al., 2019); and one quantitative article (Ali, et al., 2020). Preterm births are a leading

cause of neonatal mortality, increasing in low and middle-income countries. In addition,

preeclampsia is the cause of many preterm births. Therefore, controlling hypertension during

pregnancy and preventing preeclampsia can help to reduce the number of premature births

(Hoffman et al., 2020).

Hoffman et al., 2020 utilized a randomized multi-country placebo-controlled study from

March 2016 through June 2018, to evaluate the effects of daily administration of low-dose

aspirin (81 mg) daily amongst nulliparous women with a singleton pregnancy to prevent

preeclampsia and premature births (Hoffman et al., 2020). The study was conducted by the

NICHD Global Network for Women’s and Children’s Health Research in seven sites in six

countries including the Democratic Republic of Congo, Guatemala, India, Kenya, Pakistan, and

Zambia (Hoffman et al., 2019). A purposeful sampling of 11,976 nulliparous pregnant women

between 14 and 40 years of age was selected for the study. Participants had to consent to

randomization to move forward with the trial. In addition, participants agreed to a health

assessment to meet the medical screening criteria of blood pressure > 140/90 mmHg,

hemoglobin of over 7.0 g/dl; and an ultrasound evaluation to confirm the presence of a fetal

heartbeat, single gestation, and absence of any fetal anomalies (Hoffman et al., 2020).

Participants were randomized in a 1:1 ratio and assigned to a daily regimen of 81 mg of

aspirin (5,990 women) or a placebo (5,986) (Hoffman et al., 2020). Medications were given daily

between 6 weeks 0 days and 13-weeks 6 days gestation through the end of the participant’s

pregnancy (Hoffman et al., 2020). Participants were given drugs packaged as a 2-week supply.

(Hoffman et al., 2020) As participants picked up their medications every two weeks, they were

assessed for compliance, side-effects, and any over-the-counter medications being used were
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documented. Each participant’s blood pressure was evaluated between 16 to 20 weeks, 28 to

30 weeks, and biweekly starting at the 34 weeks of gestation until delivery (Hoffman et al.,

2020).

Data analysis of binary outcomes included a Cochran-Mantel-Haenszel test per site.

Researchers used the data to test their primary hypothesis formally. A generalized linear model-

based sensitivity analysis was obtained for relative risk (RR). The secondary outcome was

exploratory, where p-values and confidence intervals are provided for descriptive purposes and

were not adjusted for multiple comparisons. The primary result of preterm delivery before 37

weeks occurred in 11.6% of women assigned to the aspirin regimen and 13.1% for women

assigned to the placebo group (RR, 0.089%, 95%CI, 0.81 to 0.98; RD, -0.02; 95% CI, -0.03, -

0.01). Secondary outcomes for early preterm delivery (<34 weeks) were reduced in women in

the aspirin group compared to the placebo group (3.3% vs. 4.0%; RR, 0.75; 95%CI, 0.61 to

0.93). (Hoffman et al., 2020) Statistically significant findings showed that prescribing low-dose

aspirin (81 mg) to prevent preeclampsia can reduce the risk of premature births by 25% and

reduce perinatal mortality by 16%. (Hoffman et al., 2020)

Low-dose aspirin to prevent spontaneous preterm births

Ibrahim et al., 2019 conducted a randomized, double-blind controlled trial. The study

aimed to improve pregnancy outcomes and reduce the number of spontaneous preterm births

with the intervention of low-dose aspirin. The study also sought to evaluate the cost-

effectiveness of low-dose aspirin as a prophylactic in preventing spontaneous preterm births.

The study included 120 pregnant women assigned to two groups, low-dose aspirin (60 women)

and placebo (60 women). The study was conducted in the Department of Obstetrics and

Gynecology at the Suez Canal University Hospital in Egypt. The study was conducted from

August 2017 through March 2018. Study participants met the inclusion criteria of being between

18 -25 years, primigravida and Multipara, singleton pregnancy with a gestation age between 16

weeks through 36 weeks. In addition, participants had to be deemed a high-risk preterm

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pregnancy, have a history of one or more preterm births, preeclampsia from a previous

pregnancy, and a history of gestational diabetes mellitus (Ibrahim et al., 2019).

Personal health history and obstetric medical history were obtained for each participant. A

general examination was also completed to include vital signs (blood pressure, pulse, body

temperature and assessment for lower extremity edema. Participants also underwent an

obstetric examination to check fundal height and signs of palpable contractions, cervical

ripening. An ultrasound was competed to confirm gestational age, number of fetuses and to

assess fetal anomalies (Ibrahim et al., 2019).

The control group consisted of pregnant women with a high risk for preterm birth. The

group was treated with folic acid (5 mg) and other conventional therapies for preterm birth such

as progesterone, cervical cerclage, tocolytics, and steroids. The Interventional group was

treated with the same interventions as the control group in addition to low-dose chewable

aspirin (81 mg). Each group received continuous follow-up for 36-weeks or up until delivery.

(Ibrahim et al., 2019) Urine analysis and laboratory screenings such as renal function, blood

glucose levels, CBCs, and WBCs were completed. An analysis of both groups based on

outcome was done by gestational age during the time of delivery.

Quantitative data was expressed as mean plus standard deviation; qualitative data were

expressed as numbers and percentages. A student t-test was utilized to test the significance of

difference for quantitative variables, and chi-square was used to test the difference for

qualitative variables. A probability value of less than 0.05 was considered statistically significant

(Ibrahim et al., 2019). The study results showed a statistically significantly lower rate of

spontaneous preterm labor among the study group (8.3%) than 16.67% in the control group.

The occurrence rates of spontaneous preterm delivery according to the treatment arm showed a

statistically lower rate in the study group when compared to the control group (8.3% versus

16.7%, p=0.043) with a relative risk of 0.67 (95% CI, 0.41 – 1.03) (Ibrahim et al., 2019).

Statistically significant findings were that adding low-dose aspirin reduced the number of
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preterm births in the interventional group versus the controlled group. Additionally, the study

showed that low-dose aspirin is the cost-effective prophylactic treatment for preterm births in

low-resource healthcare settings (Ibrahim et al., 2019).

Discussion and Implications for Practice

The research articles used for this integrative review suggest the benefits of using low-

dose aspirin as a prophylactic to prevent preeclampsia and spontaneous preterm births. The

three studies incorporate data from clinical trials conducted on high-risk pregnant women for

preterm birth and preeclampsia. All articles show a positive effect of low-dose aspirin at

preventing preeclampsia and reducing the number of preterm births. The research studies

provide information in support of the PICO question, “For pregnant women diagnosed with

preeclampsia (P) does the use of low-dose aspirin (I) compared to women not treated with low-

dose aspirin (C) reduce the risk of premature births (O)?”. Each study also showed a positive

effect of low-dose aspirin if administered before 20 weeks gestation. Early intervention between

weeks 6 and 0 days and 13 weeks and 6 days gestation reduced the risk for preeclampsia.

Most patients are not aware or diagnosed with preeclampsia until they present to the hospital

exhibiting symptoms of premature birth (Hoffman, et al., 2020). Data collection and monitoring

for each study was conducted at a healthcare facility where patients could receive immediate

care and medical attention if needed. Additionally, each study followed study participants

through 37 weeks or time of delivery, whichever came first. (Ali, et al., 2020; Hoffman et al.,

2020; Ibrahim et al., 2019)

One difference among the studies was the research designs. One research design was

a randomized, double-blind controlled trial (Ibrahim et al., 2019), one was a randomized

placebo-controlled study Hoffman, et al., 2020), and the other was a quantitative clinic-based

cohort study (Ali, et al., 2020) Differences also included therapy regimens. One study used low-

dose aspirin only (81 mg) (Hoffman et al., 2020), one used a combination of low-dose aspirin

and other preterm birth therapies such as folic acid (5 mg), progesterone, and tocolytics
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(Ibrahim et al., 2019), one used low-dose aspirin combined with immunoglobulin, low molecular

weight heparin, levothyroxine, progesterone, folic acid, and human chorionic gonadotrophin and

other medications (Ali, et al., 2020).

The implication of these findings suggests that the use of low-dose aspirin (81 mg) alone

or in combination with other therapies can prevent premature births. Low-dose aspirin is a cost-

effective medication that can be utilized in all healthcare settings, making it accessible for all

pregnant patients (Ibrahim et al., 2019). Based on the research, early low dose-aspirin

intervention may help control hypertension and prevent preeclampsia (Hoffman, et al., 2020).

However, the use of low-dose aspirin in combination with other preterm birth medications to

prevent spontaneous preterm births may need further investigation with a larger sample group

(Ibrahim, et al., 2019).

Limitations

The articles utilized in this integrated review demonstrated further research into the use

of low-dose aspirin alone to prevent spontaneous preterm births. The study conducted by

Ibrahim, et al., 2019 showed positive results for the interventional group, which included the

treatment of low-dose aspirin and other premature labor therapies. However, the sample size of

120 participants was smaller compared to similar clinical trial sample sizes (Ibrahim, et al.,

2019). However, Ibrahim, et al., 2019 reported that their findings coincide with results from other

research studies such as Sliver et, al. (Ibrahim, et al., 2019). In addition, Hoffman et al., 2020

reported limitations with their research to include utilizing the intervention of low-dose aspirin

beyond the nulliparous women with a singleton gestation. Another limitation noted was other

meta-analyses have suggested that increased doses of aspirin (>100 mg) may have a more

significant impact on the incidence of preeclampsia (Hoffman et al, 2019).

Value of Practice

In summary, the research utilized in this integrative review examined the implementation

of early prophylactic low-dose aspirin in preventing preeclampsia and spontaneous premature

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births. The research findings suggest that early intervention of low-dose aspirin can significantly

reduce the incidence of premature births and preeclampsia in pregnant women. Additionally,

results from these studies confirm that prophylactic treatment of low-dose aspirin in pregnant

women is safe and cost-effective and shows no evidence of causing harm to the mother or the

fetus. Whereas hypertensive medications used to treat preeclampsia can cause adverse effects,

such as, dizziness, hypotension, nausea, and vomiting. The use of low-dose aspirin can also

help mothers at high risk for preterm births reach 36 to 37 weeks gestation, which increases the

neonates survival rate outside of the womb (Ali, et al., 2020; Hoffman et al., 2020; Ibrahim et al.,

2019). The findings of the research articles support the PICO question, “For pregnant women

diagnosed with preeclampsia does the use of low-dose aspirin compared to women not treated

with low-dose aspirin reduce the risk of premature births?”. The finding concludes that low-dose

aspirin can help mothers at high risk for preterm births reach 36 to 37 weeks gestation (Ali, et

al., 2020; Hoffman et al., 2020; Ibrahim et al., 2019).

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References

Ali, Shafat, et al. “Evaluation of Etiology and Pregnancy Outcome in Recurrent Miscarriage

Patients.” Saudi Journal of Biological Sciences, vol. 27, no. 10, Oct. 2020, pp. 2809–

2817, 10.1016/j.sjbs.2020.06.049. Accessed 31 Oct. 2021.

Hoffman, Matthew K, et al. “Low-Dose Aspirin for the Prevention of Preterm Delivery in

Nulliparous Women with a Singleton Pregnancy (ASPIRIN): A Randomised, Double-

Blind, Placebo-Controlled Trial.” The Lancet, vol. 395, no. 10220, Jan. 2020, pp. 285–

293, www.thelancetcom/journals/lancet/article/PIIS0140-6736(19)32973-3/fulltext,

10.1016/s0140-6736(19)32973-3. Accessed 28 Jan. 2020.

Ibrahim, Zakia M, et al. “Low Dose Aspirin in Prevention of Spontaneous Preterm Birth in Suez

Canal University Hospital.” Madridge Journal of Internal and Emergency Medicine, vol.

3, no. 2, 28 Oct. 2019, pp. 146–151, 10.18689/mjiem-1000133. Accessed 31 Oct. 2021.

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Appendix: Summary of the Literature Table

APA Citation / Author (Ali, S., Majid, S., Niamat Ali, Md., Taing, S., El-Serehy, H. A., & Al-Misned, F. A. (2020).
Qualifications Evaluation of etiology and pregnancy outcome in recurrent miscarriage patients. Saudi Journal of
Biological Sciences, 27(10), 2809–2817. https://doi.org/10.1016/j.sjbs.2020.06.049

First author is a faculty member of the University of Kashmir in Srinagar, India in the division of
Cytogenetics and Molecular Biology Laboratory, Centre for Research for Development. He also works
the Department of Biochemistry at the Government Medical College in Srinagar, India. For this particular
research, the first author collected patient data, samples and performed experiments. In addition, he
wrote the journal article and developed the tables.
Background/ Problem Spontaneous abortion is a significant obstetric medical issue in more than two-thirds of conceptions,
Statement impacting about 15-35% of pregnancies. Recurring miscarriages are often related to other underlying
health conditions that are not medically managed during pregnancy. Additionally, idiopathic recurring
miscarriages can be treated and managed with supplements and other medical therapies (Ali et al.,
2020).
Conceptual or The evaluation of the etiology and pregnancy outcome of recurrent miscarriages that occur related to
Theoretical various health condition and the number of idiopathic recurrent miscarriages.
Framework

Research Design (i.e. Research Design: Quantitative

qualitative, quantitative) Specific Design: Phenomenology (Cohort Study)
/ Philosophical underpinnings: The number of recurring miscarriages that occur related to various
Specific Design (i.e. health conditions and the number of idiopathic recurrent miscarriages.
Phenomenology,
Experimental) /
Philosophical
Underpinnings (for
qualitative designs
only)

Sample (size, type, Sample: Purposeful sampling of 280 pregnant patients who experienced three or more failed clinically
sampling method) / documented conceptions ending before 20 weeks of fetal development. In addition to the failed
Geographical pregnancies, study participants also needed to be diagnosed with other health conditions before
location/ Setting/ pregnancy that may have contributed to recurrent miscarriages (Ali et al., 2020).
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Ethical Geographical location/Setting: Kashmir, India. Outpatient antenatal clinics at the Department of
Considerations Obstetrics and Gynecology in Government Medical College. The study was approved by the Institutional
Ethical Committee of Government Medical College in Kashmir, India.

Ethical Considerations: N/A

Type of Data Variables for this study are independent and relate directly to the patient’s recurrent miscarriage
Collected (Major management therapies prescribed to manage their pre-existing health conditions.
Variables Studied-
independent, The independent variable is the low-dose aspirin and its effects on preventing preeclampsia and
dependent and their premature births. Dependent variable is the pregnant women gestational term.
definitions), if
appropriate

Measurement Tools/ All participants were given recurrent miscarriage management therapies to assist with carrying gestation
Method of Data to full term during their pregnancy period. Therapeutic regimens were given either single or combined
Collection (i.e. BP cuff, doses depending on the number of etiologies the patient had (Ali et al., 2020).
Visual analog scale,
Beck Depression Index)

Data Analysis (ex. Data for the two groups (Primary and Secondary) were compared using the Chi-square test and t-test.
Statistical tests used or Results for each group assumed of statistical significance at p <0.05. (Ali et al., 2020). Data was
Content/Thematic collected during participants scheduled visits to the antenatal clinic. (Ali et al., 2020)
analysis. NOT software
[i.e. NUD*st or SPSS or
SAS])

Findings (i.e. The live birth rate among women with recurrent miscarriages can improve by 75.7% after therapeutic
statistically significant management of single and combined therapy regimens that include Levothyroxine, progesterone, folic
or descriptive or acid, hCG, LMWH, LDA, VD3, genetic counseling, psychotherapies.
themes) /
Discussion The number of live births for both the primary and secondary RM groups was improved based on
therapeutic management. The number of live births for the primary RM group was 73.6% and 81.6% for
the secondary RM group. Based on the results, introducing therapeutic management for primary and
secondary RM can increase the number of live births (Ali et al. 2020).
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Preterm mortality was observed less frequently among women prescribed the low-dose aspirin
compared to the placebo group. However, the therapeutic effect on hypertensive disorders of pregnancy
was not different between women in the two groups (low-dose aspirin and placebo groups).
Appraisal/ Value to This study may help physicians improve the live birth rate for mothers with recurring miscarriages; by
Practice based on deciding on specific medical regimens to treat various health conditions that contribute to frequent
PICOT Question miscarriages, specifically for patients with an endocrine health condition.
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Appendix: Summary of the Literature Table

APA Citation / Author Hoffman, et al., 2020). Low-dose aspirin for the prevention of preterm delivery in nulliparous women
Qualifications with singleton pregnancy: A randomized multi-country placebo-controlled trial. Lancet, 395(10220),
285-293.

First author holds a medical degree and master’s in public health and works for the Department of
Obstetrics & Gynecology at Christiana Care Hospital in Newark, DE.
Background/ Problem Preterm births are a leading cause of neonatal mortality, increasing in low and middle-income
Statement countries. In addition, preeclampsia is the cause of many preterm births. Therefore, controlling
hypertension during pregnancy and preventing preeclampsia can help to reduce the number of
premature births (Hoffman, et al., 2020).
Conceptual or This study evaluates the effects of low-dose aspirin (81 mg) on preventing preeclampsia to decrease
Theoretical Framework the number of preterm births. The article also explores the outcome of initiating the administration of
low-dose aspirin before 14-weeks gestation to avoid misdiagnosis or preeclampsia premature birth
hospital admissions (Hoffman, et al., 2020).
Research Design (i.e. Research Design: Qualitative
qualitative, quantitative) Specific Design: Phenomenology (Randomized double masked study)
/ Philosophical underpinnings: Reducing the number of preterm births caused by preeclampsia.
Specific Design (i.e.
Phenomenology,
Experimental) /
Philosophical
Underpinnings (for
qualitative designs only)

Sample (size, type, Sample: Purposeful sampling 14,361 women nulliparous pregnant women between 14 years and 40
sampling method) / years of age with singleton pregnancies.
Geographical location/
Setting/ Geographical location/Setting: Democratic Republic of Congo, Guatemala, India, Kenya, Pakistan
Ethical Considerations and Zambia.

Ethical Considerations: Some pregnant women had to be at least 18 years if required by individual
ethics boards.
Type of Data Collected The patient's blood pressure was assessed between 16 and 20 weeks, 28 to 30 weeks and then
(Major Variables biweekly starting the 34 weeks until the patient delivered. In addition, study participant’s hemoglobin

Studied- independent,
dependent and their
definitions), if
appropriate
Measurement Tools/
Method of Data
Collection (i.e. BP cuff,
Visual analog scale,
Beck Depression Index)
Data Analysis (ex.
Statistical tests used or
Content/Thematic
analysis. NOT software
[i.e. NUD*st or SPSS or
SAS])
Findings (i.e.
statistically significant or
descriptive or themes) /
Discussion
Appraisal/ Value to
Practice based on
PICOT Question
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was assessed at 26-30 weeks. Maternal and neonate outcomes were obtained through 42 days using
a previously described registry. (Hoffman, et al., 2020)
The independent variable is the low-dose aspirin and its effects on preventing preeclampsia and
premature births. Dependent variable is the pregnant women gestational term.
Data was collected every two weeks. Participants’ blood pressure was assessed between 16 and 20
weeks, 28 to 30 weeks, and then biweekly starting the 34 weeks until the patient delivered.
Participants’ hemoglobin levels were evaluated at 26-30 weeks. (Hoffman, et al., 2020)
A generalized linear model with a binomial distribution and identity link was used to estimate the
adjusted absolute risk difference for the primary outcome. P-values and confidence intervals were
used to analyze secondary outcomes. (Hoffman, et al., 2020)
Statistically significant findings show that prescribing low-dose aspirin (81 mg) to prevent
preeclampsia can reduce the risk of premature births by 25% and reduce perinatal mortality by 16%.
(Hoffman, et al., 2020)
This study is of value in using low-dose aspirin to prevent preeclampsia, reduce the number of
premature births and reduce the perinatal mortality rate. Healthcare professionals can initiate this
intervention as early as 16 weeks of a woman’s pregnancy.
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Appendix: Summary of the Literature Table

APA Citation / Author (Ibrahim, Gadallah, Mahmoud, & Shora, 2019). Low dose aspirin in prevention of spontaneous preterm
Qualifications birth in Suez Canal University Hospital. Madridge Journal of Internal and Emergency Medicine, 3(2),
146-151.

The first author is a faculty member of Suez Canal University in Egypt in obstetrics and gynecology,
Faculty of Medicine. The second author is a faculty member of Port-Said University & Ismailia General
Hospital in Egypt in the molecular biology/biochemistry department (Ibrahim, et al, 2019).
Background/ Problem Preterm births are a major recurring health problem in obstetrics, affecting 15 million pregnancies
Statement worldwide annually. In addition, the use of progesterone to women with one preterm birth will most likely
have a recurring miscarriage. Therefore, interventions need to be initiated to prevent and decrease the
risk of premature births (Ibrahim, et al, 2019).
Conceptual or This study evaluates the efficacy of low-dose aspirin for preventing spontaneous preterm births and the
Theoretical cost-effectiveness of low-dose aspirin to prevent recurrent miscarriages (Ibrahim, et al, 2019).
Framework

Research Design (i.e. Research Design: Qualitative

qualitative, quantitative) Specific Design: Phenomenology (Randomized double-blind controlled trial)
/ Philosophical underpinnings: Use of low-dose aspirin in preventing spontaneous preterm births.
Specific Design (i.e.
Phenomenology,
Experimental) /
Philosophical
Underpinnings (for
qualitative designs only)

Sample (size, type, Sample:120 pregnant women randomized study with two groups, low dose aspirin group and, placebo
sampling method) / group.
Geographical
location/ Setting/ Geographical location/Setting: Suez Canal University Hospital.
Ethical
Considerations Ethical Considerations: N/A

Type of Data The independent variable is the low-dose aspirin and its effects on preventing spontaneous preterm
Collected (Major births. The Control group was treated with folic acid (5 mg), progesterone, cervical cerclage (if needed),
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Variables Studied- tocolytics and steroids. The interventional group was treated with low-dose aspirin (81 mg daily), folic
independent, acid (5 mg), progesterone, cerclage (if needed), or pessary with continuous follow-up up to 36 weeks or
dependent and their delivery (Ibrahim, et al, 2019).
definitions), if
appropriate

Measurement Tools/ Study participants' personal obstetric and medical history was collected. Each participant received a
Method of Data general examination and an ultrasound to confirm gestation age and number of fetuses. In addition,
Collection (i.e. BP cuff, laboratory samples were drawn to assess blood glucose levels, renal function, and CBC. Preterm birth
Visual analog scale, was diagnosed through uterine monitoring, digital examination, and ultrasound.
Beck Depression Index)

Data Analysis (ex. Quantitative data were expressed as mean plus standard deviation. Qualitative data were expressed as
Statistical tests used or numbers and percentages. Standard t-test was used to test the significance of difference for quantitative
Content/Thematic variables, and chi-square was used to test the significance of difference for qualitative variables (p-
analysis. NOT software value) <0.05 was considered statistically significant. (Ibrahim, et al, 2019)
[i.e. NUD*st or SPSS or
SAS])

Findings (i.e. Statistically significant findings that prophylactic low-dose aspirin in pregnant women could prevent
statistically significant spontaneous preterm births by 53.3% when given with folic acid (5 mg) and by 51.7 Additionally, the low
or descriptive or cost of aspirin will be helpful as a cost-effective prophylactic in low-resource settings (Ibrahim, et al,
themes) / 2019).
Discussion

Appraisal/ Value to The use of low-dose aspirin with or without folic acid was beneficial in reducing or preventing
Practice based on spontaneous births. However, the use of low-dose aspirin in preventing preeclampsia was not indicated
PICOT Question in this study due, possibly due to the small sample size (Ibrahim, et al, 2019).