Effectiveness and safety of 1 vs 4 h blood pressure profile with clinical and laboratory assessment for the exclusion of gestational hypertension and pre-eclampsia: a retrospective study in a university affiliated maternity hospital

Abstract

ObjectiveWe asked whether 60 compared with 240 min observation is sufficiently informative and safe for pregnancy day assessment (PDAC) of suspected pre-eclampsia (PE).DesignA retrospective study of 209 pregnant women (475 PDAC assessments, 6 months) with routinely collected blood pressure (BP), symptom and laboratory information. We proposed a 60 min screening algorithm comprising: absence of symptoms, normal laboratory parameters and ≤1high-BP reading (systolic blood pressure, SBP 140 mm Hg or higher or diastolic blood pressure, DBP 90 mm Hg or higher). We also evaluated two less inclusive screening algorithms. We determined short-term outcomes (within 4 h): severe hypertension, proteinuric hypertension and pregnancy-induced hypertension, as well as long-term outcome: PE-related diagnoses up to the early puerperium. We assessed performance of alternate screening algorithms performance using 2×2 tables.Results1 in 3 women met all screen negative criteria at 1 h. Their risk of hypertension requiring treatment in the next 3 h was 1.8% and of failing to diagnose proteinuric hypertensive PE at 4 h was 5.1%. If BP triggers were 5 mm Hg lower, 1 in 6 women would be screen-negative of whom 1.1% subsequently develops treatment-requiring hypertension and 4.5% demonstrate short-term proteinuric hypertension. We present sensitivity, specificity, negative and positive likelihood ratios for alternate screening algorithms.ConclusionsWe endorse further research into the safest screening test where women are considered for discharge after 60 min. Safety, patient and staff satisfaction should be assessed prospectively. Any screening test should be used in conjunction with good clinical care to minimise maternal and perinatal hazards of PE.

Influence of random urine albumin-creatinine ratio of pregnant women with hypertension during the gestation period on perinatal outcome

“…The APGAR score ( 8 ) included skin color, heart rate, reaction of flicking planta pedis or inserting nasal tube, muscle tension and breathing of the delivered newborn ( Table I ).…”

“…During normal pregnancy, 24-h urine protein and urinary albumin excretion increase significantly after 20 weeks to 200–300 mg and 12–19 mg, respectively. The maximum urinary protein content can reach 500 mg/24 h ( 7 , 8 ).…”

Sensitivity analysis for random measurement error using regression calibration and simulation-extrapolation

“…For the second example, we used data of retrospective records of all women who attended a tertiary maternity hospital pregnancy day assessment clinic over a 6-month period in 2014 in Australia [31]. Care always included serial, manual blood pressure measurements every 30 min by registered midwives using aneroid sphygmomanometers [31]. Serum creatinine and demographic data were obtained using routinely collected data.…”

“…Estimates were obtained from the national health and nutrition examination survey (example 1, reliability of the error-prone blood pressure measurement: 0.95) [30] and the pregnancy day and assessment clinic study (example 2, reliability of the error-prone blood pressure measurement: 0.6) [31] 2…”

Type of Delivery and Length of Stay in Hypertension Patients

“…Pregnancy induced hypertension is a complication that contributes significantly to maternal and perinatal morbidity and mortality (Uzan et al, 2011;MacDonald-Wallis et al, 2012;Kazemian et al, 2014;Kattah & Garovic, 2014;Mccarthy et al, 2015). Pregnancy induced hypertension, preeclampsia and complications occur at gestational age more than 20 weeks with maternal blood pressure at ≥ 140 / 90mmHg ( American College of Obstetricians and Gynecologists, 2013;Kattach & Garovic, 2014;Melamed et al, 2014;Magee et al, 2016;Zhang et al, 2017).…”