to Pregnancy Reviews
- Obstetricians and midwives should be aware
of the difficulties in measuring blood pressure
and proteinuria; and should try at all times
to obtain the most accurate measures.
- Korotkov phase V, the disappearance of
sounds, should be used for the measurement
of diastolic blood pressure.
- All blood pressure measuring equipment
should be adequately maintained and its accuracy
- Where possible a 24 hour urine save should
be used to quantify the amount of protein
being lost through the kidneys. However,
there are several limitations even with this "gold
standard" technique and it is important
that each local hospital is aware of the
quality controls in its host laboratory.
- Likewise dipstix need to be used with caution
and equivocal results should be checked.
- The 2 major classification systems for
the hypertensive disorders in pregnancy rely
on hypertension and proteinuria to make the
diagnosis of pre-eclampsia. However, clinicians
should be aware that the condition can present
in a multitude of ways as it affects many
organ systems within the body. This fact
has been recognised by the Australasian Society
for the Study of Hypertension in Pregnancy
and all clinicians should be wary of the
unusual presentation of the disease pre-eclampsia.
- The drugs which are first line agents to
treat hypertension in pregnancy are Methyldopa
and Labetalol with Nifedipine being the second
line agent. For acute crises Hydralazine
has the longest track record but there is
evidence now that Nifedipine is equally as
good if not better.