A good test for predicting women who will develop preeclampsia should be simple, rapid, noninvasive, inexpensive, easy to perform, and should not expose the patient to discomfort or risk The technology should be widely available and the results reproducible and reliable, with a high likelihood ratio for a positive test (>15) and a low likelihood ratio for a negative result (<0.1) and good sensitivity and specificity. Ideally, it should provide an opportunity for intervention to prevent development of the disease, or at least result in better maternal and/or fetal outcomes.
Currently, there are no clinically available tests that perform well according to these guidelines in distinguishing women who will develop preeclampsia from those who will not.
Even if there were such a test, for it to be useful there would have to be some proven intervention that would produce clinically important benefits. Whilst the meta-analyses of antiplatelet agents suggest small benefits, these are biased by small old trials on selected patients. The package of prediction and prevention in order to produce a meaningful benefit has not been subjected to large RCTs.
Aspirin has been suggested as the panacea. However, there is no evidence that it significantly reduces perinatal mortality, and there remains a possibility of rare but serious adverse effects. The optimal dose and timing of administration remain unclear. The current Australian practice of 100 mg in the morning is probably not enough and not at the right time.