Background The Centre for Maternal and Child Enquires Saving Mother’s Lives report, 2006–2008, ranks preeclampsia second in the direct causes of maternal death in the UK.1 Preeclampsia is associated with increased perinatal mortality. NICE clinical guideline 107: Hypertension in Pregnancy, indicates patients with defined risk should receive aspirin 75mg daily or serial ultrasound for fetal growth and umbilical Doppler assessment every 4 weeks from 28–30 weeks gestation.2
Aims/Objectives To assess if women with identifiable risk factors for preeclampsia at the booking appointment are being appropriately managed according to NICE guidance.
Materials/Methods A 50 day, prospective data collection of all deliveries in a tertiary referral centre. 846 charts included, 25 charts not located. Notes were reviewed for evidence of appropriate management in patients with risk factors for pre-eclampsia. Notes were reviewed to identify those who developed hypertension.
Results 821 charts were reviewed. 117 patients had risk factors for preeclampsia, 100 requiring aspirin 75mg, 12 requiring serial growth scans and umbilical artery Doppler assessment and 5 requiring both interventions. 33 out of 117 cases were managed appropriately.
14 patients with risk factors developed pre-eclampsia which required induction of labour or caesarean section, of these, 6 had not been risk managed appropriately.
Summary/ Conclusions Booking appointments could be better utilised to identify those at risk of developing preeclampsia, institute appropriate management and ultimately improve obstetric outcome. Staff education on guidance and review of booking interview structure is advised to ensure these patients are correctly identified. We plan to re-audit in 1 year.
Saving Mothers’ Lives: reviewing maternal deaths to make motherhood safer 2006–2008. British Journal of obstetrics and gynaecology 2011;118(1):1–203
National Institute of Health and Clinical Excellence. Hypertension in Pregnancy CG107, NICE: London, 2010