Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.
Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, Pennsylvania.
Am J Perinatol. 2021 May;38(6):544-552. doi: 10.1055/s-0040-1718580. Epub 2020 Oct 24.
This study aimed to evaluate the utilization of aspirin for preeclampsia prevention before and after implementation of a screening tool during nuchal translucency (NT) ultrasound.
One-year prospective cohort study of patients at high risk for preeclampsia after the implementation of a screening tool (postscreen) administered to all patients at check in for NT (11-13 weeks) ultrasound. Prospective cohort was compared with one-year retrospective cohort (prescreen) the year prior (2017). All patients who presented for NT ultrasound in both cohorts were evaluated for the presence of one or more risk factor for preeclampsia with screening tool collected prospectively and chart review retrospectively. Provider recommendation for aspirin determined by documentation in prenatal record. Primary outcome was rate of provider recommendation for aspirin pre versus post screening tool, compared by Chi-square test and adjusted for potential confounders with multiple regression analysis.
Pre- ( = 156) and postscreen ( = 136) cohorts were similar except for race and multifetal gestation. Prescreen, rate of provider recommendation for aspirin was 74%. Of those with prior preeclampsia, 96% were recommended aspirin, compared with 64% of patients with other risk factors ( < 0.001). Postscreen, provider recommendation of aspirin improved to 95% ( < 0.001). Rate of preeclampsia/gestational hypertension were similar between cohorts; however, there was a reduced adjusted risk in overall preterm birth <37 weeks (adjusted odds ratio [aOR] = 0.50 [0.25-0.99]) and preterm birth <34 weeks (aOR = 0.33 [0.13-0.88]) postscreening tool implementation.
Prior to implementation of a simple screening questionnaire, approximately 25% of high risk patients did not receive the recommendation of aspirin for preeclampsia prevention. High-risk patients who lack a history of preeclampsia were less likely to be advised of aspirin prophylaxis. Use of a simple universal screening tool at time of NT ultrasound significantly improved utilization of aspirin for preeclampsia prevention and may improve patient outcomes.
· Despite recommendations, aspirin use for preeclampsia prevention is suboptimal.. · High-risk patients who lack a history preeclampsia were less likely to be advised of aspirin use.. · A simple universal screening tool can significantly improve aspirin utilization..
本研究旨在评估在颈项透明层（NT）超声检查中使用筛查工具前后，阿司匹林用于子痫前期预防的应用情况。
这是一项前瞻性队列研究，对实施筛查工具（postscreen）后的高危子痫前期患者（11-13 周 NT 超声检查时）进行评估。前瞻性队列与前一年（2017 年）的回顾性队列（prescreen）进行比较。在两个队列中，所有接受 NT 超声检查的患者均采用筛查工具评估子痫前期的一个或多个危险因素，并前瞻性收集数据，回顾性查阅病历。阿司匹林的推荐意见由产前记录中的文件决定。主要结局是与筛查工具应用前相比，应用后提供者推荐阿司匹林的比例，采用卡方检验比较，并采用多元回归分析调整潜在混杂因素。
pre-（ = 156）和 postscreen（ = 136）队列除种族和多胎妊娠外，其他方面相似。在 prescreen 队列中，阿司匹林的推荐率为 74%。在有既往子痫前期病史的患者中，96%的患者推荐使用阿司匹林，而有其他危险因素的患者中只有 64%（ < 0.001）。postscreen 后，阿司匹林的推荐率提高到 95%（ < 0.001）。两组子痫前期/妊娠期高血压的发生率相似；然而，实施筛查工具后，总体早产<37 周（校正优势比[aOR] = 0.50[0.25-0.99]）和早产<34 周（aOR = 0.33[0.13-0.88]）的校正风险降低。
在实施简单的筛查问卷之前，约 25%的高危患者未接受阿司匹林预防子痫前期的建议。缺乏子痫前期病史的高危患者不太可能被建议使用阿司匹林预防。在 NT 超声检查时使用简单的通用筛查工具可显著提高阿司匹林预防子痫前期的使用率，并可能改善患者结局。
·尽管有建议，但阿司匹林用于子痫前期预防的使用率仍不理想。·缺乏子痫前期病史的高危患者不太可能被建议使用阿司匹林。·简单的通用筛查工具可显著提高阿司匹林的使用率。
