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

Ngene, Nnabuike Chibuoke; Moodley, Jagidesa

doi:10.5830/cvja-2018-067

Cited by 12 publications

(14 citation statements)

References 72 publications

(92 reference statements)

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“…This type of sphygmomanometer is more portable and preferable for community-level health services than any other BP measuring devices, though considered less accurate than a mercury sphygmomanometer. 21 22 To minimise the variation in measurements during reassessment, BP was measured two times for each ANC recipient in the same hand (right arm, unless there was any clinical or physical condition), on a sitting position, and at 5 min of resting interval between two measurements. Both measurements were recorded during the reassessment by the study physicians and the average of these two measurements was used in the statistical analysis.…”

Section: Methodsmentioning

confidence: 99%

Competency of health workers in detecting and managing gestational hypertension, pre-eclampsia, severe pre-eclampsia and eclampsia during antenatal check-ups in primary care health facilities in Bangladesh: a cross-sectional study

et al. 2021

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Study objectiveTo evaluate the competency of trained health workers in detecting and managing hypertensive disorders of pregnancy during routine antenatal check-ups (ANCs) at primary care facilities in Bangladesh.Study design and settingsCross-sectional study; conducted in 26 primary care facilities.Outcome measuresAccurate diagnosis of the hypertensive disorders of pregnancy.MethodIn total 1560 ANC consultations provided by primary health workers, known as Family Welfare Visitors (FWVs), were observed using a structured checklist between October 2017 and February 2018. All consultations were reassessed by study physicians for validation.ResultOf the ‘true’ cases of gestational hypertension (n=32), pre-eclampsia (n=29) and severe pre-eclampsia (n=16), only 3%, 7% and 25%, respectively, were correctly diagnosed by FWVs. Per cent agreement for the diagnosed cases of any hypertensive disorders of pregnancy was 9% and kappa statistics was 0.50 (p value 0.0125). For identification of any hypertensive disorders by FWVs, sensitivity and positive predictive values were 14% and 50%, respectively. There was a moderate positive correlation between the blood pressure measurements taken by FWVs and study physicians. Only 27% of those who had ‘some protein’ in urine were correctly identified by FWVs. Women diagnosed with any of the hypertensive disorders of pregnancy by FWVs were more likely to be counselled on at least one danger sign of pre-eclampsia (severe headache, blurring of vision and upper abdominal pain) than those without any such diagnosis (41% vs 19%, p value 0.008). All four cases of severe pre-eclampsia diagnosed by FWVs were given a loading dose of intramuscular magnesium sulphate and three among them were referred to a higher facility.ConclusionThe FWVs should be appropriately trained on risk assessment of pregnant women with particular emphasis on accurately assessing the diagnostic criteria of hypertensive disorders of pregnancy and its management.

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Section: Methodsmentioning

confidence: 99%

Competency of health workers in detecting and managing gestational hypertension, pre-eclampsia, severe pre-eclampsia and eclampsia during antenatal check-ups in primary care health facilities in Bangladesh: a cross-sectional study

et al. 2021

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“…11,12 Studies done in South Africa show that a standard technique and BP devices validated in pregnancy should be used for BP measurements. 13 Any elevation in BP or increases from basal BP levels should be repeated within 15 min and patients should be referred to the appropriate health facility timeously using the national maternity care guidelines. 6 There is also evidence from the charts reviewed that eclampsia may occur abruptly.…”

Section: Blood Pressure Levelsmentioning

confidence: 99%

Maternal deaths due to eclampsia in teenagers: Lessons from assessment of maternal deaths in South Africa

Moodley

Ngene

2020

African Journal of Primary Health Care & Family Medicine

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Background Eclampsia remains a major cause of maternal mortality, particularly in teenage pregnancies. Healthcare professionals providing antenatal must regard teenagers as a high risk group for the pre-eclampsia-eclampsia syndrome. Setting Data extracted from the South African Saving Mothers Report: 2014–2016. Aim To establish the clinical details in teenage maternal deaths owing to eclampsia. Method Retrospective review of the case records and maternal death assessment forms of teenagers that died due to eclampsia during 2014–2016. Results There were 47 teenagers (aged 14 to 19 years) who died from eclampsia. Of these 18 out of 47 (38%) deaths occurred in the post-partum period. Forty (85.1%) of the patients had antenatal care. Three (6.4%) had post-partum eclampsia, and of the remaining 44 of the 47 (93.6%), the gestational age at first occurrence of a seizure ranged from 25 to 39 weeks. The blood pressures at the time of seizure ranged from systolic of 131 to 210 mmHg and diastolic of 89 to 130 mmHg. The commonest final causes of death were intracerebral haemorrhage associated with severe hypertension and multi-organ failure. Avoidable factors included transport delays, referral to the wrong levels of health care and poor care by health professionals. Conclusion Teenage pregnancy is a risk factor for eclampsia-related death; awareness of borderline elevations of blood pressure levels from baseline values (prehypertension levels) and taking following national guidelines on the management of hypertensive disorders of pregnancy will decrease deaths from eclampsia.

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“…Hypertensive disorders of pregnancy (HDP) occur in 5% -10% of pregnancies and account for 14% of maternal deaths worldwide. 1,2 The burden of the disease is highest in low-and middleincome countries. 1 In South Africa for instance, HDP accounts for 18% of maternal deaths 3 and this is because of high prevalence (9.6% for pre-eclampsia [PE]), 4 the propensity for the severe forms of the disease 5 and avoidable factors associated with their management.…”

Section: Introductionmentioning

confidence: 99%

“…1,2 The burden of the disease is highest in low-and middleincome countries. 1 In South Africa for instance, HDP accounts for 18% of maternal deaths 3 and this is because of high prevalence (9.6% for pre-eclampsia [PE]), 4 the propensity for the severe forms of the disease 5 and avoidable factors associated with their management. 6 In 2018, the International Society for the Study of Hypertension in Pregnancy (ISSHP) categorised HDP into chronic hypertension, PE, which may be de novo or superimposed on chronic hypertension, white coat hypertension, masked hypertension, transient gestational hypertension (TGH) and gestational hypertension.…”

Section: Introductionmentioning

confidence: 99%

“…3 Transient gestational hypertension is the brief occurrence of hypertension (systolic blood pressure [BP] of ≥ 140 mmHg and or diastolic BP of ≥ 90 mmHg) at ≥ 20 gestational weeks, followed by normalisation of BP without treatment. 1,7 Unfortunately, clinical management of TGH is rarely reported. Transient gestational hypertension progresses to gestational hypertension in 20% of cases and PE in 19% of cases 8 and may result in maternal and foetal complications such as placental insufficiency.…”

Section: Introductionmentioning

confidence: 99%

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Transient gestational hypertension and pre-eclampsia: Two case reports and literature review on the need for stringent monitoring

Ngene

Daef

2021

South African Family Practice

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Transient gestation hypertension is a contributor to adverse pregnancy outcomes particularly when it progresses to pre-eclampsia (PE). This requires frequent monitoring. We illustrate the need for stringent monitoring of gestational hypertension, transient gestational hypertension (TGH) and PE without severe features and conducted a brief rapid review of the literature. Two cases are presented: Firstly, a 25-year-old primigravida at 30 gestational weeks who had an isolated TGH with high blood pressure (BP) of 141/87 mmHg, which was not investigated. Four weeks later, she presented with a BP of 202/128 mmHg, imminent eclampsia and intrauterine foetal death and had an uncomplicated induction of labour and delivered a 1400 g macerated male stillborn. Secondly, a 30-year-old primigravida at 30 gestational weeks who developed PE but her monitoring was compromised initially by inadequate healthcare capacity including unavailability of hospital bed-space for inpatient care and later by poor clinic attendance as a result of poor finances. At 32 gestational weeks, she presented with decreased foetal movement and was diagnosed as haemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome and intrauterine foetal death. She was stabilised, had induction of labour and delivered a 1400 g male macerated stillborn. Thereafter, the need for her to go home to complete the cultural burial rites of her baby and the pressure from her workplace resulted in an inadequate postpartum follow-up care. In conclusion, transient gestational hypertension is associated with adverse maternal and foetal outcomes, including foetal demise. Unavailability of hospital bed-space and poor personal finances interfere with stringent monitoring of hypertensive disorders and can be associated with adverse pregnancy outcomes. Stringent laboratory monitoring in these cases is defined by the authors as testing at least blood levels of serum Creatinine, Haemoglobin concentration, Alanine transaminase and Platelet count (abbreviated as ‘CHAP’) weekly.

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

Cited by 12 publications

References 72 publications

Competency of health workers in detecting and managing gestational hypertension, pre-eclampsia, severe pre-eclampsia and eclampsia during antenatal check-ups in primary care health facilities in Bangladesh: a cross-sectional study

Competency of health workers in detecting and managing gestational hypertension, pre-eclampsia, severe pre-eclampsia and eclampsia during antenatal check-ups in primary care health facilities in Bangladesh: a cross-sectional study

Maternal deaths due to eclampsia in teenagers: Lessons from assessment of maternal deaths in South Africa

Transient gestational hypertension and pre-eclampsia: Two case reports and literature review on the need for stringent monitoring

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