Bij de Weg Jeske M, van Doornik Rebecca, van den Auweele Kim L H E, de Groot Christianne J M, de Boer Marjon A, de Vries Johanna I P
Department of Obstetrics and Gynaecology, Amsterdam University Medical Center, Amsterdam, the Netherlands.
Royal Dutch Association of Midwives, Utrecht, the Netherlands.
Eur J Midwifery. 2024 Aug 1;8. doi: 10.18332/ejm/191161. eCollection 2024.
Aspirin nowadays is widely used in pregnancy, but implementation among gynecologists took nearly four decades. For a complete insight in the implementation of aspirin, community midwives are to be involved. Community midwives do not have authority to prescribe aspirin and have to refer to a general practitioner or consultant obstetrician for a prescription.
The study was an online, national pilot survey about the implementation of aspirin use during pregnancy among independently practicing community midwives consisting of 29 items with five categories: background, advising, prescribing, possible indications, and clinical practice.
Forty-seven community midwives completed the survey between April and May 2021. All respondents had experience on advising aspirin use in pregnancy. History of preterm pre-eclampsia or HELLP syndrome was identified as a risk factor for developing utero-placental complications by 97.9% of the community midwives. Moderate risk factors in women with otherwise low-risk pregnancy were identified by >75% of the participants. Practical issues in prescribing aspirin were experienced by one-third of the respondents. Suggestions were made to obtain authority for community midwives to prescribe aspirin and improve collaboration with consultant obstetricians and general practitioners.
Community midwives seem to be adequate in identifying risk factors for developing utero-placental complications in women with otherwise low-risk pregnancy. Practical issues for prescribing aspirin occur often. Obtaining authority for community midwives to prescribe aspirin after education should be considered and consulting a consultant obstetrician should become more accessible to overcome the practical issues. Further educating community midwives and general practitioners might improve implementation rates and perinatal outcomes.
如今阿司匹林在孕期被广泛使用，但在妇科医生中的应用却花了近四十年时间。为了全面了解阿司匹林的应用情况，社区助产士也应参与其中。社区助产士无权开具阿司匹林处方，必须转诊给全科医生或产科顾问以获取处方。
该研究是一项关于独立执业的社区助产士在孕期使用阿司匹林情况的全国性在线试点调查，包含29个项目，分为五个类别：背景、建议、处方、可能的适应症和临床实践。
2021年4月至5月期间，47名社区助产士完成了调查。所有受访者都有在孕期建议使用阿司匹林的经验。97.9%的社区助产士将早产子痫前期或HELLP综合征病史确定为发生子宫胎盘并发症的危险因素。超过75%的参与者确定了其他低风险妊娠女性的中度危险因素。三分之一的受访者遇到了开具阿司匹林处方的实际问题。有人建议赋予社区助产士开具阿司匹林处方的权力，并改善与产科顾问和全科医生的合作。
社区助产士似乎有能力识别其他低风险妊娠女性发生子宫胎盘并发症的危险因素。开具阿司匹林处方的实际问题经常出现。应考虑在教育后赋予社区助产士开具阿司匹林处方的权力，并且应使咨询产科顾问变得更加便捷，以解决实际问题。进一步培训社区助产士和全科医生可能会提高应用率和改善围产期结局。
