LAUSR

Introduction This study evaluates former obstetric care as usual (Expect I) with risk-dependent care using a prediction tool (Expect II). The Expect I study externally validated 39 prediction models using data of 2,614 women prospectively included from 2013 to 2015. Clinically useful models were embedded in a web-based prediction tool. Additionally, risk-dependent care paths were developed, resulting in antenatal care tailored to the outcomes of individual risk assessments. Risk-dependent care was embraced by a consortium of obstetric healthcare professionals in the Dutch province of Limburg. Objective This part focuses on adherence of healthcare professionals and compliance of women to key recommendations; e.g. adequate calcium intake in all women and low-dose aspirin treatment in women at increased risk of preeclampsia. Methods Women receiving risk-dependent care are being enrolled in a prospective multicenter cohort (Expect II) and receive four questionnaires at intervals. Preliminary results Ten months after introduction our prediction tool is being used in an estimated 24–40% of pregnant women in our region. Currently, 435 women have been enrolled. Recommendations regarding calcium intake were discussed with 351 women (81%), of which 285 (81%) reported the intention to comply (Expect I, adequate calcium intake in 34% of women). In case of an elevated preeclampsia risk (n = 223) aspirin treatment was discussed with 180 women (76%), of which 52 (29%) intended to comply (Expect I, actual use in the high-risk group: 1.5%). Discussion The preliminary results indicate risk-dependent care has been implemented by a reasonable proportion of healthcare professionals. Furthermore, usage of the prediction tool increases recommendation of preventive interventions. Implementing new guidelines asks an additional effort of healthcare professionals, especially if it includes novel strategies such as a prediction tool. Future research should focus on barriers that hamper the adherence of healthcare professionals to risk-dependent care and on reasons for non-compliance of women.