Preeclampsia prevention starts with a shared plan
Identify risk early. Discuss prevention. Keep the plan visible.
Project source: Nadia Kendrick, MSN, FNP-BC · DNP student, Georgia Southern University
Quality improvement initiative at Atlanta Perinatal Associates
Clinical guidance and proposed project workflow are labeled separately. Reviewed September 30, 2026.
Know your risk, your plan, and when to call
Understand your choices
Learn what preeclampsia means, who may benefit from aspirin, and which symptoms need urgent care.
Start patient education →Make prevention reliable
Apply risk criteria, counsel patients, and document the decision using a signed paper checklist.
Go to provider toolkit →A prevention plan belongs in the conversation and in the chart.
Sources: ACOG patient FAQ [5]; Kendrick project materials [8].
Preeclampsia affects blood pressure and organs
Preeclampsia is a pregnancy condition involving high blood pressure and signs that organs may be affected.
Blood pressure
It may rise even when you feel well.
Organs
The kidneys, liver, brain, or lungs may be affected.
Pregnancy
It can affect the placenta, the organ that supports the baby's growth.
It usually starts after 20 weeks. It can also develop after birth.
Sources: ACOG patient FAQ [5]; USPSTF evidence review [4].
Share your history before or early in pregnancy
Discuss prior pregnancy problems and long-term conditions.
Bring a medication list and tell your team about allergies.
Ask whether aspirin is appropriate and when to start.
Prevention starts with a clinical conversation. Do not start aspirin on your own.
Sources: ACOG patient FAQ [5]; USPSTF recommendation [3].
Risk screening asks about more than today's symptoms
Medical and pregnancy history
Prior preeclampsia, high blood pressure before pregnancy, diabetes, kidney disease, autoimmune illness, or twins may matter.
Other parts of your story
Your first pregnancy, age, family history, fertility treatment, and access to care also help your clinician assess risk.
On the chart form, choose “not sure” when you do not know. Your clinician will review the answers.
Sources: ACOG/SMFM advisory [1]; USPSTF [3]. Form workflow: local adaptation of project [8].
Low-dose aspirin can lower risk for eligible patients
Lower the chance
A small daily dose can reduce the chance of preeclampsia in people at increased risk.
Keep your checks
Aspirin does not eliminate risk or treat preeclampsia that has already developed.
“Prophylaxis” means treatment used to help prevent a condition.
Sources: USPSTF recommendation [3] and randomized-trial evidence review [4].
Agree on the dose and start date with your clinician
for eligible patients
Guidance continues daily aspirin until delivery. Follow your clinician's individualized instructions.
Sources: ACOG/SMFM advisory [1]; ACOG Committee Opinion 743 [2].
Tell your clinician about allergies, bleeding, and medicines
Past reactions
Report reactions to aspirin or anti-inflammatory medicines, including breathing problems.
Bleeding or ulcers
Tell your clinician about bleeding, stomach ulcers, or serious liver problems.
Other medicines
Bring a complete list, including blood thinners, over-the-counter products, and supplements.
Your clinician weighs the benefits and risks before recommending aspirin.
Source: ACOG Committee Opinion 743, contraindications section [2].
Discuss anything that makes the daily plan difficult
Access
Can you obtain the medicine? Tell the team about cost or pharmacy barriers.
Routine
Ask about a reminder that fits your day and what to do if you miss a dose.
Questions
Share side effects or concerns. Do not change the dose on your own.
Try teach-back: “Here is how I will follow the plan.”
Project counseling aim [8]. Practical support and teach-back are implementation suggestions.
Aspirin does not replace prenatal or postpartum checks
Prevention
Follow the aspirin plan if your clinician recommends it.
Detection
Keep appointments and blood pressure checks. Follow any home-monitoring instructions.
Before leaving, know your follow-up date and who to contact with concerns.
Sources: ACOG patient FAQ [5]; USPSTF blood pressure screening recommendation [6].
Warning signs need medical care right away
Headache or vision changes
A severe headache that persists or worsens; blurred vision or seeing spots.
Severe pain or breathing trouble
Severe belly pain, trouble breathing, or chest pain.
Contact your care team immediately. If you cannot reach them, go to the emergency department. Call 911 for a life-threatening emergency.
These are examples, not a complete symptom list. Tell the team you are pregnant or recently gave birth.
Sources: CDC Hear Her warning signs [7]; ACOG patient FAQ [5].
Ask your MFM specialist for a written plan
About prevention
- What raises my risk?
- Should I take aspirin?
- What dose, start date, and stop plan should I follow?
About follow-up
- What if I miss a dose or have side effects?
- Do I need home blood pressure checks?
- Who do I call, including after hours?
Bring these questions to your next visit. Ask for an interpreter when needed.
Sources: ACOG patient FAQ [5]; CDC patient conversation guidance [7].
Make the same assessment reliable at every visit
Nadia Kendrick's proposed 12-week initiative standardizes screening, counseling, and aspirin decisions during routine prenatal care.
Project aim
Improve delivery and documentation of evidence-based prevention.
Paper adaptation
A signed chart checklist replaces the proposed EHR smart-phrase workflow.
Source: Kendrick project materials, pp. 1-5 [8]. No completed outcomes were supplied. Paper workflow is the user's requested adaptation.
One high-risk factor supports an aspirin recommendation
Prior preeclampsia
Especially with an adverse outcome.
Multifetal gestation
Twins or higher-order multiples.
Chronic hypertension
Hypertension before pregnancy.
Pregestational diabetes
Type 1 or type 2.
Kidney disease
Autoimmune disease
Such as SLE or antiphospholipid syndrome.
Confirm the history and review contraindications before prescribing.
Sources: ACOG/SMFM advisory [1]; USPSTF recommendation [3].
Assess moderate risk and social context
Multiple factors
First pregnancy; prepregnancy BMI >30; age ≥35; mother/sister with preeclampsia; IVF; personal history factors.
Personal history includes low birth weight/SGA, prior adverse pregnancy outcome, or >10-year pregnancy interval.
Equitable assessment
Black racial identity and lower income are also moderate-risk factors. ACOG/SMFM allows consideration with either alone.
The risk reflects structural inequities and racism, not biological race.
Recommend aspirin with more than one moderate-risk factor; individualize and document the assessment.
Sources: ACOG/SMFM updated advisory [1]; USPSTF [3].
Use one form with clear roles and a signed clinical plan
Identify the encounter, report history, and route urgent concerns to clinical staff.
Confirm risk, review safety, counsel, and record the aspirin decision.
Reconcile follow-up and confirm all pages are filed in the correct chart.
Download the 3-page chart checklist →
Local paper adaptation of Kendrick project [8]. Staff do not interpret risk or authorize aspirin. No eClinicalWorks smart note is required.
Screen, assess safety, counsel, and record the decision
Resolve “not sure” responses. Document gestational age.
Review dose, timing, contraindications, and medicines.
Benefits, limits, risks, access, and patient preference.
Record decision, follow-up, and clinician signature.
A checked box supports the record; it does not replace clinical judgment.
Project workflow [8]; clinical eligibility and safety guidance [1-3].
Document why aspirin is or is not used
Project decision categories
Initiated · Continued
Not indicated · Patient declined
Clinical exceptions
Contraindicated · Temporarily held
Pending clarification · Planned start
Record the rationale, actual or planned start date, dose, and follow-up. A justified nonprescription is not automatically a protocol failure.
Four original categories: project pp. 1, 4 [8]. Exception fields: paper adaptation. Final research coding must be defined by the investigator.
Measure care processes before claiming better outcomes
Screening
Was the risk assessment completed?
Counseling
Was appropriate counseling documented?
Decision
Was the aspirin decision recorded?
Gestational age
When did screening and the decision occur?
Completed checklist ≠ medication adherence ≠ demonstrated reduction in preeclampsia.
Source: proposed 12-week evaluation, project pp. 1-2, 5 [8]. No project results are available in the supplied document.
Keep the clinical chart and research extract separate
Clinical record
Keep the completed form in the correct patient chart under the practice's access and retention policies.
Research extract
Use approved study IDs and de-identified fields. The researcher should not receive names, MRNs, or signed chart pages.
Download the de-identified audit worksheet →
Project privacy approach [8]. Paper adaptation and audit definitions require investigator/local protocol alignment before study use.
Practice the next step, not just the facts
Patient scenario
You take prescribed aspirin but develop a severe persistent headache and blurred vision.
What should you do?
Seek medical care immediately. Aspirin does not rule out preeclampsia.
Provider scenario
At 13 weeks, a patient has chronic hypertension. No aspirin contraindication is found.
What should you do?
Recommend guideline-directed low-dose aspirin, discuss benefits and risks, and document the shared plan.
Sources: CDC warning signs [7]; ACOG/SMFM advisory [1]. Hypothetical educational cases.
Identify risk early and close the loop
- Screen early: use a complete history and revisit uncertainties.
- Confirm eligibility: consider both risk factors and contraindications.
- Optimize timing: plan the start, dose, and duration explicitly.
- Support daily use: ask about access, concerns, and follow-through.
- Keep monitoring: explain urgent signs and the follow-up plan.
Sources: ACOG/SMFM [1]; ACOG [2]; USPSTF [3,6]; CDC [7].
Aspirin is supported; higher doses and implementation need scrutiny
Established
Randomized-trial synthesis supports preventive aspirin in increased-risk pregnancies. US guidance recommends 81 mg.
Dose uncertainty
A 2026 trial did not establish superior efficacy of 162 mg over 81 mg and reported an abruption imbalance.
Next research
Does the paper workflow improve screening, counseling, timely initiation, and equitable access?
Research on higher doses does not make 162 mg the default for this project.
Sources: ACOG/SMFM [1]; Henderson et al. [4]; Khander et al., 2026 [9]. No completed Kendrick outcomes [8].
Clinical recommendations have traceable sources
- ACOG and SMFM. Low-Dose Aspirin Use for the Prevention of Preeclampsia and Related Morbidity and Mortality. Practice Advisory. December 2021; reaffirmed October 2022.
- ACOG Committee Opinion No. 743. Low-Dose Aspirin Use During Pregnancy. Obstet Gynecol. 2018;132:e44-e52. doi:10.1097/AOG.0000000000002708.
- Davidson KW, et al.; USPSTF. Aspirin Use to Prevent Preeclampsia and Related Morbidity and Mortality. JAMA. 2021;326:1186-1191. doi:10.1001/jama.2021.14781.
- Henderson JT, Vesco KK, Senger CA, Thomas RG, Redmond N. Updated Evidence Report and Systematic Review for the USPSTF. JAMA. 2021;326:1192-1206. doi:10.1001/jama.2021.8551.
Guidance verified for this educational deck on September 30, 2026.
The project source describes methods, not results
- ACOG. Preeclampsia and High Blood Pressure During Pregnancy. Patient FAQ.
- USPSTF. Hypertensive Disorders of Pregnancy: Screening. Final recommendation. September 19, 2023.
- CDC. Urgent Maternal Warning Signs and Symptoms. Hear Her campaign. May 15, 2024. Also: patient conversation guidance.
- Kendrick N. Strengthening Preeclampsia Prevention in At-Risk Pregnant Women Through a Standardized Low-Dose Aspirin Prophylaxis Protocol. Unpublished project materials supplied by user, undated, pp. 1-5. Georgia Southern University. No completed results supplied.
- Khander A, et al. Comparison of 162 mg and 81 mg Aspirin for Prevention of Preeclampsia: A Randomized Controlled Trial. Obstet Gynecol. 2026;147:87-96. doi:10.1097/AOG.0000000000006100.
Use education to support an individualized care plan
Ask about risk. Write down the plan. Keep follow-up visible.
For your visit
Print the chart checklist →Complete it with the care team and retain it in the clinical chart.
For the research team
Print the audit worksheet →Use only the approved de-identified extraction process.
Educational material, not diagnosis, a prescription, research consent, or enrollment. Care decisions belong to the treating clinician. This presentation does not collect personal health information.
OpenMFM · Paper tools adapted from Nadia Kendrick's project at the user's request · Version 1.0, September 30, 2026