Automated measurement of blood pressure and urinalysis is reviewed, and the strengths and weaknesses of these devices are compared with conventional techniques. The few early reports of such management strategies are reviewed with emphasis on the advantages of automated monitoring. The article concludes with a review of published pilot data in this field and places those findings in the context of recent recommendations for the development of obstetric care in the United Kingdom.
1. Department of Health. Report on confidential enquiries into maternal deaths in the UK 1994-1997. London: HMSO, 1998.
2.
2. Redman CWG. Pathophysiology of pre-eclampsia—why is it dangerous? In: Pater N, ed. Maternal mortality—The way forward. Royal College of Obstetricians and Gynaecologists. UK: Chameleon Press Ltd., 1992:14-20.
3.
3. National High Blood Pressure Program Working Group: Report on high blood pressure in pregnancy. Am J Obstet Gynaecol1990;163:1689-1712.
4.
4. Redman CWG, Jefferies M. Revised definition of pre-eclampsia. Lancet1988;1:809-812.
5.
5. PerrY IJ, Beevers DG. The definition of pre-eclampsia. Br J Obstet Gynaecol1994;101:587-591.
6.
6. Rosenburg K, Twaddle S. Screening and surveillance of pregnancy hypertension—An economic approach to the use of day care. Balliere's Clin Obstet Gynaecol1990;4:89-107.
7.
7. Anthony J. Improving antenatal care. The role of the antenatal assessment unit. Health Trends1992;24:123-125.
8.
8. Ales KL, Frayer W, Hawks G, Auld PM, Druzin ML. Development and validation of a multivariate predictor of mortality in very low birth weight. J Clin Epidemiol1988;41:1095-1103.
9.
9. Kierse MJNC, Canhay HHH. An observational viewpoint on preterm birth with particular reference to perinatal mortality and morbidity. In Huijses HJ, ed. Aspects of perinatal morbidity. Roningen: Universitaire Boekhandel Nederland, 1981:1-35.
10.
10. Tubman TRJ, Rowlands MD, Paterson C, Halliday HL. Increased incidence of respiratory distress syndrome in babies of hypertensive mothers. Arch Dis Childhood199;66:52-54.
11.
11. O'Brien E, O'Malley K. Techniques for measuring blood pressure and their interpretation. In: Birkenhager W, ed. Practical management of hypertension. London, UK: Kluwer Academic Publications, 1990; 1-24.
12.
12. Kuo V, Koumantakis G, GAllerY E. Proteinuria and its assessment in normal and hypertensive pregnancy. Am J Obstet Gynaecol1992;167:723-728.
13.
13. Brown M, Buddle M, Friedman S, Sibai B. Inadequacy of dipstick proteinuria in hypertensive pregnancy. Aust N Z J Obstet Gynaecol1995;35:366-369.
14.
14. Staessen JA, Byttebier G, Buntinx F, Celis H, O'Brien E, Fagard R, for the Ambulatory Blood Pressure Monitoring and Treatment Investigators. Antihypertensive treatment based on conventional blood or ambulatory blood pressure measurement. A randomised controlled trial. JAMA1997;278:1065-1072.
15.
15. Chatellier G, Clair D, Laurenne V, et al. Home blood pressure measurement in general practice (the SMART study). Am J Hypertens1996;9:644-652.
16.
16. Conceicao S, Ward M, Kerr D. Defects in sphygmomanometers: an important source or error in blood pressure recording. BMJ1976;1:886-888.
17.
17. Perry IJ, Wilkinson LS, Shinton RA, Beevers DG. Conflicting views on the measurement of blood pressure in pregnancy. Br J Obstet Gynaecol1991;98:241-243.
18.
18. Rayburn W, Schnoor T, Brown D, Smith C. “White coat” hypertension during pregnancy. Hypertens Pregnancy1993;12:191-197.
19.
19. Association for the Advancement of Medical Instrumentation. American National Standard. Electronic or automated sphygmomanometers. Arlington, Virginia: Association for the Advancement of Medical Instrumentation, 1993.
20.
20. O'Brien E, Petrie J, Littler W, et al. An outline of the revised British Hypertension Society protocol for the evaluation of blood pressure measuring devices. J Hypertens1993;11:677-679.
21.
21. Shennan AH, Kissane J, de Swiet M. Validation of the Spacelabs 90297 ambulatory blood pressure monitoring system in pregnancy. Br J Obstet Gynaecol1993;100:904-908.
22.
22. Shennan AH, Halligan A, Gupta M, Taylor D, de Swiet M. Oscillometric blood pressure measurements in severe preeclampsia: Validation of the Spacelabs 90207. Br J Obstet Gynaecol1996;103:171-173.
23.
23. Penny JA, Shennan AH, Rushbrook J, Halligan ATaylor DJ, de Swiet M. Validation of the Welch Allyn QuietTrak ambulatory blood pressure monitor in pregnancy. Hypertens Pregnancy1996;15:313-321.
24.
24. Shennan AH, de Swiet M. Oscillometric blood pressure measurement in severe pre-eclampsia: validation of the Spacelabs 90207 [letter]. Br J Obster Gynaecol1996;103:722-722.
25.
25. Gupta M, Shennan AH, Halligan A, Taylor DJ, de Swiet M. Accuracy of oscillometric blood pressure monitoring in pregnancy and pre-eclampsia. Br J Obstet Gynaecol1997;104:350-355.
26.
26. Penny JA, Shennan AH, Halligan AW, Taylor DJ, de Swiet M, Anthony J. Blood pressure measurement in severe pre-eclampsia. Lancet1997;349:1518-1518.
27.
27. Padfield PL, Benediktsson R. Ambulatory blood pressure monitoring: From research to clinical practice. J Hum Hypertens1995;9:413-416.
28.
28. O'Brien E, Staessen J. Normotension and hypertension as defined by 24 hour ambulatory blood pressure monitoring. Blood Pressure1995;4:266-282.
29.
29. Penny JA, Halligan AWF, Shennan AH, et al. Automated, ambulatory, or conventional blood pressure measurement in pregnancy: Which is the better predictor of severe hypertension?Am J Obstet Gynecol1998;178:521-526.
30.
30. Waugh JJS, Birthweight and twenty four hour ambulatory blood pressure in non-proteinuric hypertensive pregnancy. Am J Obstet Gynaecol2000;183:633-637.
31.
31. Aylett M. Ambulatory or self-blood-pressure measurement? Improving the diagnosis of hypertension. Fam Pract1994;11:197-200.
32.
32. Barton JR, Stanziano GJ, Sibai BM. Monitored outpatient management of mild gestational hypertension remote from term. Am J Obstet Gynaecol1994;170:765-769.
33.
33. Rayburn WF, Zuspan FP, Piehl EJ. Self monitoring of blood pressure during pregnancy. Am J Obstet Gynecol1984;148:159-162.
34.
34. Ross McGill H, Hewison J, Hirst J, et al. Antenatal home blood pressure monitoring: A pilot randomised controlled trial. Br J Obstet Gynaecol2000;107:217-221.
35.
35. Ferrazani S, Caruso A, Carolis SD, Martino I, Mancuso S. Proteinuria and outcome of 444 pregnancies complicated by hypertension in pregnancy. Am J Obstet Gynecol1990;162:366-371.
36.
36. Chua S, Redman C. Prognosis for pre-eclampsia complicated by 5g or more of proteinuria in 24 hours. Eur J Obstet Gynaecol1988;29:121-127.
37.
37. Meyer NL, Mercer BM, Friedman SA, Sibai BM. Urinary dipstick protein: A poor predictor of absent or severe proteinuria. Am J Obstet Gynaecol1994;170:137-141.
38.
38. Jachevatzky O, Rosenberg R, Shalit A, Zonder H, Grunstein S. Protein:creatinine ratio in random urine specimens for quantitation of proteinuria in pre-eclampsia. Obstet Gynecol1990;75:604-606.
39.
39. Boler L, Zbeller EA, Gleicher N. Quantitation of proteinuria in pregnancy by the use of single voided urine samples. Obstet Gynecol1987;70:99-100.
40.
40. Saudan P, Brown M, Farrell T, Shaw L. Improved methods of assessing proteinuria in hypertensive pregnancy. Br J Obstet Gynaecol1997;104:1159-1164.
41.
41. Quadri KHM, Bernardini J, Greenberg A, Laifer S, Syed A, Holley JL. Assessment of renal function during pregnancy using a random urine protein:creatinine ratio and Cockcroft-Gault formula. Am J Kidney Dis1994;24:416-420.
42.
42. Bell SC, Armstrong CA, Shennan AH, Boyce T, Halligan AWF. Relaible urine analysis inthe management of hypertensive pregnancies. Eur J Obset Gynaecol Reprod Biol2000;93:181-183.
43.
43. Armstrong C, Shennan AH, Halligan AWF. Point of care testing in pre- and antenatal care. In: Price CP, Hicks JM, eds. Point of care testing. AACC Press, 1999.
44.
44. Garcia J. Women's use of antenatal care.In Enkin M, Chalmers I, eds. Effectiveness and satisfaction in antenatal care. London, UK: Spastics International Medical Publications/Heinemann Medical Books, 1982:81-91.
45.
45. Reid M, Garcia J. Women's views of care during pregnancy and childbirth. In: Chalmers I, Enkin M, Kierse M, eds. Effective care in pregnancy and childbirth. Oxford University Press, 1989:131-142.
46.
46. Department of Health. Changing childbirth: Report of the Expert Maternity Group. London, UK: HMSO, 1993.
47.
47. Audit Commission. First class delivery. London, UK: Audit Commission, 1997.
