Blood pressure measurement in pregnancy

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.