Knowledge, practice patterns, and guideline implementation for pre-eclampsia risk management among obstetricians in China: an exploratory cross-sectional survey.

Background: 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. Methods: 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. Results: 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. Conclusions: 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.