Efficiency of administering low dose aspirin to prevent preeclampsia based on NICE guideline – a policy to practice gap in antenatal care in a rural Sri Lankan district

The NICE guideline on managing pregnancy induced hypertension recommends a low dose aspirin as prophylaxis for pre-eclampsia. Eligibility for aspirin is assessed using risk factor-based evaluation using major and moderate risk factors. Understanding prevalence of risk factors as per guideline and the level of adherence of clinicians to guideline are important in managing pre-eclampsia. This study aimed to assess the prevalence of major and moderate risk factors for pre-eclampsia in this population as per NICE guidelines and to understand the clinician's level of adherence to the guideline. A cross-sectional study was carried out in the professorial unit, Teaching Hospital, Anuradhapura, Sri Lanka using a structured data collection sheet to collect data from pregnant women admitted for delivery within a period of one month. Out of 420 pregnant women, 20 (4.5%) had major or moderate risk factors and eligible for aspirin prophylaxis as per NICE guideline. But only seven (35%) of them were identified based on the guideline and given aspirin during antenatal care. There were 11 (2.6%) women with major risk factors but only five were identified and from nine women with moderate risk factors, only two were identified as eligible. Comparatively, identifying eligibility based on major risk factors was higher than moderate risk factors. Although the prevalence of risk factors of preeclampsia is low, there is a gap between NICE guideline recommendations and the actual practice among clinicians in antenatal care from this rural district. Clinicians should be provided with updated information on NICE guideline to improve recognizing risk factors and prescribing aspirin.