Precise Blood Pressure Measures Vital in Pregnancy

Accurate blood pressure (BP) measurement is key in detecting hypertensive disorders that contribute to more than half of all maternal deaths.

Researchers from the Women’s Academic Health Centre at King’s College London reviewed current literature to learn how to obtain accurate BP measurements in pregnant patients and identify factors that produce inaccurate readings.

In terms of inaccuracies, the investigators found poor auscultatory technique and lack of training lead to flawed BP measurement using sphygmomanometry with mercury and aneroid devices. Although automated devices limit this user error, measurements still require validation because the devices tend to underestimate BP in preeclampsia.

“There are several things clinicians can do to increase the accuracy of their BP measurement, such as becoming more aware of the advantages and disadvantages of the various available devices; having the confidence to raise concerns regarding any devices that are inaccurate for use in pregnancy; and correcting any poor techniques they’ve observed,” said study co-author Andrew H. Shennan, MBBS, MD, FRCOG, in a press release.

In their review, which was published in The Obstetrician & Gynaecologist (TOG), the researchers also said systolic hypertension may better predict a pregnant patient’s risk of hemorrhagic stroke and other adverse outcomes compared with diastolic hypertension. Additionally, ambulatory and self-monitoring increases the number of BP readings on which health care providers can base hypertension management, thus curbing unnecessary treatment.

“The ability to measure blood pressure accurately is an indispensable skill for obstetricians, midwives, and other health care workers, regardless of setting, in order to prevent maternal and perinatal morbidity and mortality,” TOG Editor in Chief Jason Waugh said in the press release. “This review is helpful in enabling clinicians to do everything they can to ensure that their BP measurement is accurate.”

Many maternal deaths are linked to substandard care, which typically results from poor recognition of hypertension severity and treatment necessity. The lack of inexpensive, exact, simple BP measuring devices continues to be a hurdle in low- and middle-income countries with the highest risk of maternal and perinatal mortality and morbidity secondary to preeclampsia and shock.