中国产科医生先兆子痫风险管理的知识、实践模式和指南实施：一项探索性横断面调查

摘要(中文译文)

子痫前期仍然是全球孕产妇发病率和死亡率的主要原因。然而，关于在中低收入环境中实施风险管理战略的证据仍然有限。这项探索性调查评估了中国产科医生对先兆子痫风险管理的知识、临床实践、指南实施和感知障碍。在中国产科医生中进行了一项基于网络的探索性横断面调查，该调查使用了便利性和雪球抽样。基于两步先兆子痫风险管理策略，开发了一份38项的匿名问卷，并通过学术网络和专业团体分发。使用分类变量的频率和比例以及连续变量的四分位数范围中位数进行描述性分析。根据参与者特征进行探索性亚组分析。根据中国使用的四项指南中的关键建议，对指南的遵守情况进行了评估。在307名产科医生中，91.9%的人报告进行了先兆子痫风险预测，主要基于病史、产科病史和当前妊娠因素。然而，评估时间和风险分类方法存在相当大的差异。尽管FMF竞争风险模型被认为很重要，但只有61.6%的人听说过该模型，36.5%的人报告了临床应用。生物标志物可用性有限和缺乏自动化计算工具是主要障碍。低剂量阿司匹林预防被广泛报道，90.9%的人为中高风险女性开具阿司匹林处方。最常见的方案是每天一次100mg，在12周时开始，在36周时停止。只有56.0%的人报告在16周前开始服用阿司匹林，1.0%的人报告继续服用直至分娩，这表明阿司匹林的管理存在很大差异。这项探索性调查表明，中国的产科医生已经将先兆子痫风险管理的一些组成部分纳入临床实践，但在指南实施方面仍存在很大差异。标准化风险评估工具的有限采用和不一致的阿司匹林预防策略突显了潜在的改进领域。加强实施支持和改善循证工具的获取可能有助于更一致的先兆子痫预防实践。

Abstract

Pre-eclampsia remains a leading cause of maternal morbidity and mortality worldwide. However, evidence regarding the implementation of risk management strategies in low- and middle-income settings remains limited. This exploratory survey assessed knowledge, clinical practices, guideline implementation, and perceived barriers related to pre-eclampsia risk management among obstetricians in China. A web-based exploratory cross-sectional survey using convenience and snowball sampling was conducted among obstetricians in China. An anonymous 38-item questionnaire was developed based on two-step pre-eclampsia risk management strategies and distributed through academic networks and professional groups. Descriptive analyses were performed using frequencies and proportions for categorical variables and medians with interquartile ranges for continuous variables. Exploratory subgroup analyses were conducted by participant characteristics. Guideline adherence was assessed against key recommendations from four guidelines used in China. Among 307 obstetricians, 91.9% reported performing pre-eclampsia risk prediction, primarily based on medical history, obstetric history, and current pregnancy factors. However, considerable variation existed in assessment timing and risk classification approaches. Although the FMF competing-risk model was recognized as important, only 61.6% had heard of the model and 36.5% reported clinical use. Limited biomarker availability and lack of automated calculation tools were the main barriers. Low-dose aspirin prophylaxis was widely reported, with 90.9% prescribing aspirin for women at moderate or high risk. The most common regimen was 100 mg once daily, initiated at 12 weeks and discontinued at 36 weeks. Only 56.0% reported initiating aspirin before 16 weeks, and 1.0% reported continuation until delivery, indicating substantial variation in aspirin management. This exploratory survey suggests that obstetricians in China have incorporated some components of pre-eclampsia risk management into clinical practice, but substantial variability remains in guideline implementation. Limited adoption of standardized risk assessment tools and inconsistent aspirin prophylaxis strategies highlight potential areas for improvement. Enhancing implementation support and improving access to evidence-based tools may facilitate more consistent pre-eclampsia prevention practices.

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