The World Health Organization lists hypertensive disorders in pregnancy as one of the leading causes of maternal death. It is also known that each year more than 10 million women worldwide suffer from preeclampsia, one of the hypertensive disorders in pregnancy. The accuracy of blood pressure measurement is crucial to making the correct diagnosis and treatment of hypertensive disorders of pregnancy. Taking a BPM is one of the most basic clinical assessments that is done by members of the healthcare team. However, it is often one of the most inaccurately performed assessments. Accurate measurement is critical for proper diagnosis, assess risk, and correct treatment. Inaccurate assessments can cause delay in diagnosis of a hypertensive disorder and increase risks to the mother and child. Conversely, falsely elevated measurements can lead to unnecessary treatments that may be harmful. The American College of Cardiology/American Heart Association recommended guidelines for performing Blood Pressure Measurements that include not smoking, exercising, or drinking caffeinated beverages for 30 minutes prior to measurement. Measurements are taken after 5‐minutes rest in a seated position with arms at the level of the heart without talking. Two measurements, one minute apart, should be taken, preferably with a stethoscope and manual blood pressure cuff, with the average of the values recorded as the blood pressure measurement. Our study aimed to fill a critical gap in knowledge of how blood pressure measurement using the ACC/AHA gold standard guideline compared to routinely taken clinical blood pressures of pregnant women.

Pregnancy Predictors of Health, University of Iowa Obstetrics and Gynecology Postgraduate Virtual Conference, November 5, 2021Poster Presentations

The Challenge of Maternal Mortality, University of Iowa Obstetrics and Gynecology Postgraduate Virtual Conference, November 20, 2020. Poster presentations.

Hypertension in pregnancy is a leading cause of maternal morbidity and mortality. Studies demonstrate that body positions affect the blood pressure (BP) measurements and have led to guidelines for proper positioning by the ACC and AHA. However, studies excluded pregnant women and did not include all common patient positions, such as semi-Fowlers. These studies cannot be applied to pregnant women due to dynamic cardiovascular changes in pregnancy. We measured BP in pregnant women in inpatient and outpatient settings in various positions. These BPs were compared to the published ACC/AHA guideline position: seated with arms and feet supported. Trained team members used an aneroid sphygmomanometer and stethoscope and/or a validated electronic BP machine. There is no significant difference between BP measurements using a sphygmomanometer/stethoscope vs. an electronic BP machine in the ACC/AHA guideline position (systolic p=0.60 diastolic p=0.91). There was not a significant difference in either systolic or diastolic means in the semi-Fowlers position (at 45 degrees measured by goniometer) (systolic=0.60 diastolic=0.95). Positioning did affect the diastolic BP measurement in the seated without support position (p=0.01) and both the systolic (p< 0.001) and diastolic (p<0.001) measurements in the left lateral recumbent position. Our data demonstrate that an accurate BP measurement in pregnancy is dependent upon patient position. Monitoring BP position in left lateral recumbent may mask an elevated BP. This study also suggests that it may be possible to substitute semi-Fowlers position for reliable BP measurements when chair sitting is not practical, such as labor.