The booking visit that prevents preeclampsia — communication and decision station

Communication and shared-decision station: the booking risk assessment that must convert into a prescription. Tests risk stratification without biomarker screening, the full aspirin and calcium prescription, addressing a specific medication fear with evidence, adherence problem-solving, culturally safe communication, and building a surveillance plan a regional service can deliver. Includes assessor timeline, marking domains, assessor key and fail criteria.

Prompt

A 41-year-old G3P2 books at 12+1 weeks in a regional hospital antenatal clinic. Both previous pregnancies were uncomplicated and delivered at term. Her body mass index is 38 kg/m2, she has type 2 diabetes on metformin, and her mother had eclampsia. Her blood pressure today is 132/84 mmHg with clear urinalysis. She tells you she 'does not like taking tablets in pregnancy' and that a friend told her aspirin causes miscarriage. There is no first-trimester combined preeclampsia screening service at this hospital.

Station brief

Format. Communication and shared-decision station with a simulated patient, approximately 12 minutes. You are the obstetric registrar at a regional hospital booking clinic. The assessor observes and may interject as the woman. ^[7]

Candidate instruction. Complete this woman's preeclampsia risk assessment, explain it to her, negotiate a preventive plan she will actually follow, and set out the surveillance she will receive. ^[1]^[7]

References8Show

[1]Davidson KW, Barry MJ, Mangione CM, et al. Aspirin Use to Prevent Preeclampsia and Related Morbidity and Mortality: US Preventive Services Task Force Recommendation Statement JAMA, 2021.PMID 34581729
[2]Henderson JT, Vesco KK, Senger CA, Thomas RG, Redmond N Aspirin Use to Prevent Preeclampsia and Related Morbidity and Mortality: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force JAMA, 2021.PMID 34581730
[3]Rolnik DL, Wright D, Poon LC, et al. Aspirin versus Placebo in Pregnancies at High Risk for Preterm Preeclampsia N Engl J Med, 2017.PMID 28657417
[4]Roberge S, Nicolaides K, Demers S, et al. The role of aspirin dose on the prevention of preeclampsia and fetal growth restriction: systematic review and meta-analysis Am J Obstet Gynecol, 2017.PMID 27640943
[5]Tan MY, Wright D, Syngelaki A, et al. Comparison of diagnostic accuracy of early screening for pre-eclampsia by NICE guidelines and a method combining maternal factors and biomarkers: results of SPREE Ultrasound Obstet Gynecol, 2018.PMID 29536574
[6]Hofmeyr GJ, Lawrie TA, Atallah ÁN, Torloni MR Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems Cochrane Database Syst Rev, 2018.PMID 30277579
[7]Shanmugalingam R, Barrett HL, Beech A, et al. A summary of the 2023 Society of Obstetric Medicine of Australia and New Zealand (SOMANZ) hypertension in pregnancy guideline Med J Aust, 2024.PMID 38763516
[8]Bellamy L, Casas JP, Hingorani AD, Williams DJ Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysis BMJ, 2007.PMID 17975258

The booking visit that prevents preeclampsia — communication and decision station

Station brief

References8Show

[1]Davidson KW, Barry MJ, Mangione CM, et al. Aspirin Use to Prevent Preeclampsia and Related Morbidity and Mortality: US Preventive Services Task Force Recommendation Statement JAMA, 2021.PMID 34581729
[2]Henderson JT, Vesco KK, Senger CA, Thomas RG, Redmond N Aspirin Use to Prevent Preeclampsia and Related Morbidity and Mortality: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force JAMA, 2021.PMID 34581730
[3]Rolnik DL, Wright D, Poon LC, et al. Aspirin versus Placebo in Pregnancies at High Risk for Preterm Preeclampsia N Engl J Med, 2017.PMID 28657417
[4]Roberge S, Nicolaides K, Demers S, et al. The role of aspirin dose on the prevention of preeclampsia and fetal growth restriction: systematic review and meta-analysis Am J Obstet Gynecol, 2017.PMID 27640943
[5]Tan MY, Wright D, Syngelaki A, et al. Comparison of diagnostic accuracy of early screening for pre-eclampsia by NICE guidelines and a method combining maternal factors and biomarkers: results of SPREE Ultrasound Obstet Gynecol, 2018.PMID 29536574
[6]Hofmeyr GJ, Lawrie TA, Atallah ÁN, Torloni MR Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems Cochrane Database Syst Rev, 2018.PMID 30277579
[7]Shanmugalingam R, Barrett HL, Beech A, et al. A summary of the 2023 Society of Obstetric Medicine of Australia and New Zealand (SOMANZ) hypertension in pregnancy guideline Med J Aust, 2024.PMID 38763516
[8]Bellamy L, Casas JP, Hingorani AD, Williams DJ Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysis BMJ, 2007.PMID 17975258