Aspirin Therapy in Morbidly Obese Twin Pregnancy with Selective Fetal Growth Restriction

Introduction to Aspirin Therapy

The American College of Obstetricians and Gynecologists recommends low-dose aspirin at 100-150 mg daily for patients with morbid obesity and twin pregnancy, initiated between 12-16 weeks of gestation and continued until delivery, to prevent maternal preeclampsia 1
Morbid obesity reduces aspirin effectiveness and requires dose adjustment, with higher doses of 100-150 mg daily recommended for high-risk populations, including those with twin pregnancy and selective fetal growth restriction 2

The American College of Obstetricians and Gynecologists recommends continuing aspirin daily until delivery at 35 weeks, as stopping at 36 weeks removes protection during a high-risk period without evidence-based rationale 1
Low-dose aspirin does not increase risks of placental abruption, postpartum hemorrhage, or fetal intracranial bleeding, and is recommended to be continued until delivery 1

The American College of Obstetricians and Gynecologists recommends discontinuing aspirin 7-10 days before a scheduled cesarean section with spinal anesthesia to allow adequate platelet recovery, and verifying platelet count >75 × 10⁹/L immediately before spinal anesthesia 3
Corticosteroids may be administered up to 35 weeks 6 days for fetal lung maturity, according to UK guidelines, although most international guidelines recommend up to 34 weeks 4, 5

The American College of Obstetricians and Gynecologists recommends cesarean section for severe early-onset fetal growth restriction, with individualized decision-making based on Doppler parameters and fetal monitoring 4, 5
The combination of twin pregnancy, selective fetal growth restriction, morbid obesity, and delivery at 35 weeks strongly favors planned cesarean delivery, according to the American College of Obstetricians and Gynecologists 4, 5, 6