A review published in The Obstetrician & Gynaecologist emphasizes that accurate blood pressure measurement is vital to the early diagnosis of hypertensive disorders in pregnancy.

The article describes that blood pressure monitoring is the most important and frequent screening test in the antenatal period and that it should be performed on all women regularly. Study authors detail various factors that lead to inaccurate blood pressure measurements such as poor technique and lack of training, and state that certain methods may underestimate blood pressure in preeclampsia.

The 2006–2008 UK Confidential Enquiries Into Maternal Deaths report found that the most common reason for substandard care in deaths secondary to preeclampsia/eclampsia was failure to recognize and treat hypertension. Further, the majority of these deaths could have been avoided if early warning signs were recognized and addressed more promptly.

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Low and middle income countries account for where 99% of maternal deaths occur, the authors stated. Factors such as lack of access to cheap, easy-to-use blood pressure devices, an increased risk of maternal and perinatal mortality and morbidity secondary to preeclampsia and shock, and substandard care often contribute to poor detection of hypertension and need for treatment. About 46% of maternal deaths worldwide are due to obstetric hemorrhage, pregnancy-related sepsis, and unsafe pregnancy termination. The symptoms of these conditions can all present with signs and symptoms of shock, which can be detected through accurate blood pressure detection.

The review calls for more well-designed clinical trials for interventions in women with hypertension in pregnancy, and for more focus on the optimal predictor(s) and thresholds to guide assessment in obstetric shock. Healthcare professionals can increase the accuracy of blood pressure measurement by becoming more aware of the advantages and disadvantages of the various available devices; being confident in raising concerns regarding any devices that are inaccurate for use in pregnancy; and correcting nay poor techniques they’ve observed, the authors conclude.

For more information visit RCOG.org.uk.