272. Aspirin prescribing in pregnancy: Are we doing it?

Jakes, Adam D; Bhaduri, Mahua; Harding, Kate

doi:10.1016/j.preghy.2018.08.110

Cited by 2 publications

(5 citation statements)

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“…At the start of the implementation of our prediction tool along with the selected threshold, LDA recommendation was at best mediocre and comparable to adherence rates previously reported. 13 However, roughly after 9 months of implementation, adherence rates rose to 85% and remained consistent during the study period.…”

Section: Discussionmentioning

confidence: 88%

“…Compared to previous studies in obstetrics regarding protocol and guideline adherence, this percentage is relatively high. 10,12,13 In addition, a significant correlation was found between discussing LDA prophylaxis and the predicted PE risk. LDA prophylaxis was discussed more frequently with women having higher PE risk estimates; these women potentially have the highest individual benefit from LDA treatment.…”

Section: Discussionmentioning

confidence: 90%

“…[10][11][12] Despite the increased attention of the role of LDA in the prevention of preeclampsia, a recent conference report showed that up to 42% of women considered high risk according to the NICE guidelines had not been offered LDA. 13 This article reports on 1) the selection of a cutoff value by health care professionals for the identification of women at risk of PE using a prediction model and 2) results of health care professionals' adherence to LDA recommendations in the local guidelines.…”

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confidence: 99%

“…10–12 Despite the increased attention of the role of LDA in the prevention of preeclampsia, a recent conference report showed that up to 42% of women considered high risk according to the NICE guidelines had not been offered LDA. 13…”

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confidence: 99%

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Implementing a Preeclampsia Prediction Model in Obstetrics: Cutoff Determination and Health Care Professionals’ Adherence

et al. 2019

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Background. Despite improved management, preeclampsia remains an important cause of maternal and neonatal mortality and morbidity. Low-dose aspirin (LDA) lowers the risk of preeclampsia. Although several guidelines recommend LDA prophylaxis in women at increased risk, they disagree about the definition of high risk. Recently, an externally validated prediction model for preeclampsia was implemented in a Dutch region combined with risk-based obstetric care paths. Objectives. To demonstrate the selection of a risk threshold and to evaluate the adherence of obstetric health care professionals to the prediction tool. Study Design. Using a survey (n = 136) and structured meetings among health care professionals, possible cutoff values at which LDA should be discussed were proposed. The prediction model, with chosen cutoff and corresponding risk-based care paths, was embedded in an online tool. Subsequently, a prospective multicenter cohort study (n = 850) was performed to analyze the adherence of health care professionals. Patient questionnaires, linked to the individual risk profiles calculated by the online tool, were used to evaluate adherence. Results. Health care professionals agreed upon employing a tool with a high detection rate (cutoff: 3.0%; sensitivity 75%, specificity 64%) followed by shared decision between patients and health care professionals on LDA prophylaxis. Of the 850 enrolled women, 364 women had an increased risk of preeclampsia. LDA was discussed with 273 of these women, resulting in an 81% adherence rate. Conclusion. Consensus regarding a suitable risk cutoff threshold was reached. The adherence to this recommendation was 81%, indicating adequate implementation.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 90%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Implementing a Preeclampsia Prediction Model in Obstetrics: Cutoff Determination and Health Care Professionals’ Adherence

et al. 2019

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“…42 Moreover, despite the increased attention towards the role of low-dose aspirin in the prevention of PE, the recommendation of aspirin is still often overlooked by obstetricians. 43,44 Regarding the oral glucose tolerance test, on the other hand, most authorities have stated that nearly all women should receive an oral glucose tolerance test during their pregnancy (ie, universal screening). Nevertheless, many Western countries, like the Netherlands, still rely on selective screening strategies.…”

Section: Discussionmentioning

confidence: 99%

Impact on perinatal health and cost-effectiveness of risk-based care in obstetrics: a before-after study

Montfort

Scheepers

Dirksen

et al. 2020

American Journal of Obstetrics and Gynecology

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BACKGROUND: Obstetric health care relies on an adequate antepartum risk selection. Most guidelines used for risk stratification, however, do not assess absolute risks. In 2017, a prediction tool was implemented in a Dutch region. This tool combines first trimester prediction models with obstetric care paths tailored to the individual risk profile, enabling riskbased care. OBJECTIVE: To assess impact and cost-effectiveness of risk-based care compared to care-as-usual in a general population. METHODS: A before-after study was conducted using 2 multicenter prospective cohorts. The first cohort (2013e2015) received care-asusual; the second cohort (2017e2018) received risk-based care. Health outcomes were (1) a composite of adverse perinatal outcomes and (2) maternal quality-adjusted life-years. Costs were estimated using a health care perspective from conception to 6 weeks after the due date. Mean costs per woman, cost differences between the 2 groups, and incremental cost effectiveness ratios were calculated. Sensitivity analyses were performed to evaluate the robustness of the findings. RESULTS: In total 3425 women were included. In nulliparous women there was a significant reduction of perinatal adverse outcomes among the risk-based care group (adjusted odds ratio, 0.56; 95% confidence interval, 0.32e0.94), but not in multiparous women. Mean costs per pregnant woman were significantly lower for risk-based care (mean difference, eV2766; 95% confidence interval, eV3700 to eV1825). No differences in maternal quality of life, adjusted for baseline health, were observed. CONCLUSION: In the Netherlands, risk-based care in nulliparous women was associated with improved perinatal outcomes as compared to care-as-usual. Furthermore, risk-based care was cost-effective compared to care-as-usual and resulted in lower health care costs.

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272. Aspirin prescribing in pregnancy: Are we doing it?

Cited by 2 publications

References 0 publications

Implementing a Preeclampsia Prediction Model in Obstetrics: Cutoff Determination and Health Care Professionals’ Adherence

Implementing a Preeclampsia Prediction Model in Obstetrics: Cutoff Determination and Health Care Professionals’ Adherence

Impact on perinatal health and cost-effectiveness of risk-based care in obstetrics: a before-after study

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