The therapeutic role of aspirin in pregnancy has been examined for several decades. Recent systematic reviews have confirmed that low-dose aspirin can reduce the risk of preeclampsia,1,2 and this has been incorporated into new national guidelines.3,4 The National Institute for Health and Clinical Excellence (NICE) ‘Hypertension in Pregnancy’ guideline recommends considering low-dose aspirin for all women with one ‘high’ or two ‘moderate’ risk factors.3
A baseline retrospective audit of women who delivered in December 2010 at Nottingham City Hospital was conducted. From a total of 495 deliveries, 491 notes were reviewed and any risk factors for pre-eclampsia were identified. We then ascertained whether any had aspirin prescribed during the pregnancy.
We identified that 67 patients (13.6%) were classified by NICE criteria as high risk. Of these, 34 had at least one ‘high’ risk factor, and the remaining 33 were deemed high risk due to a combination of two or more ‘moderate’ risk factors. Four patients (0.8%) were prescribed aspirin for preeclampsia risk-reduction (5.9% of ‘high risk’ patients). There was no documentation in the notes to suggest that the use of aspirin had been discussed with any of the women who did not receive it.
This audit has demonstrated that aspirin is currently discussed with and prescribed to very few women. However, a significant proportion of women will now be recommended aspirin in pregnancy. This will require a considerable change from current management, and a re-audit will be necessary to ensure these guidelines have been incorporated into clinical practice.
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