Blood pressure measurement in pregnancy

Abstract

Key content Accurate blood pressure (BP) measurement is fundamental to early diagnosis of hypertensive disorders in pregnancy. Poor auscultatory technique and lack of training leads to inaccuracies in BP measurement using sphygmomanometry with mercury and aneroid devices. Automated devices limit user error but require validation of accuracy because they tend to underestimate BP in pre‐eclampsia. Systolic hypertension may better predict risk of adverse outcome (such as haemorrhagic stroke) than diastolic hypertension. Ambulatory/self‐monitoring increases the number of representative readings available on which to base management, limiting unnecessary intervention. Detection of hypotension in pregnancy is crucial to the diagnosis of shock secondary to haemorrhage and sepsis. Learning objectives To learn how to obtain accurate BP measurements in pregnancy. To understand the significance of hypertension in pregnancy. Ethical issues A large proportion of maternal deaths are associated with substandard care, often related to poor recognition of severity of hypertension or shock and need for treatment. Lack of cheap, accurate, easy‐to‐use BP devices in low‐ and middle‐income countries, where risk of maternal and perinatal mortality and morbidity secondary to pre‐eclampsia and shock is highest, continues to be a challenge.

Blood pressure in pregnancy—A stress test for hypertension? Five‐year, prospective, follow‐up of the ROLO study

“…Since all women measured on same device at respective timepoints, the trends observed are unlikely to be altered by device differences. 24 MAP is suggested as an indicator of future cardiovascular disease risk in nonpregnant populations. 25 Thus, MAP may act as a useful assessment tool in pregnancy to identify future HTN risk.…”

“…Although SBP and DBP are routinely measured in pregnancy, MAP is rarely calculated in clinical practice 24. This nonsignificant finding could be explained by these women already being identified as high risk for future HTN and thus managed with pharmacological treatment.…”

Out of Office Blood Pressure Measurement in Pregnancy and the Postpartum Period

“…The accurate determination of BP during pregnancy is essential, as both under- and over-treatment of HTN may result in harm to the mother and/or fetus [23, 24]. Inadequate treatment increases the risk of placental abruption and maternal stroke, while over-treatment with antihypertensive medication can potentially reduce placental perfusion pressure resulting in placental insufficiency, fetal growth restriction, and premature delivery [1, 25–28].…”

“…Of note, the hemodynamic changes and peripheral edema associated with pregnancy, and preeclampsia in particular, may affect the accuracy of the algorithms used by oscillometric devices to measure BP [23, 33]. As such, guidelines recommend separately validating BP measurement devices for accuracy among pregnant women [34–37].…”

Blood pressure measurement in pregnancy and in hypertensive disorders of pregnancy: devices, techniques and challenges

“…Then deflate the pressure at a rate of 2 mmHg/sec while auscultating the brachial artery at the cubital fossa using a functional stethoscope. 75 The pressure at which the 1st sound (Korotkoff sound) is heard represents the systolic BP and the disappearance of the sound (Korotkoff V) denotes the diastolic BP. 76 If the Korotkoff sound does not disappear, the pressure at which the sound muffles (Korotkoff IV) will denote diastolic BP.…”