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Blood pressure measurement in pregnancy

Published:November 17, 2018DOI:https://doi.org/10.1016/j.ijoa.2018.11.006
      We refer to the article on blood pressure measurement in obese pregnant women in the August edition of IJOA.
      • Eley V.A.
      • Christensen R.
      • Kumar S.
      • Callaway L.K.
      A review of blood pressure measurement in obese pregnant women.
      On page 68, the statement is made that four devices are currently validated for blood pressure measurement in pre-eclampsia. However, the article in the Journal of Hypertension to which the authors refer, also includes as validated the Microlife 3AS1-2 device, which appears to have not been referenced in the article.
      The Microlife 3AS1-2 device (now known as the Cradle VSA device, with an inbuilt traffic light system and shock detection) has been validated in accordance with the British Hypertension Society protocol requirements and achieved the International Organisation for Standardization standard for mean difference ± SD (≤5 ± 8 mmHg) in pregnancy, including in pre-eclampsia.
      • Eley V.A.
      • Christensen R.
      • Kumar S.
      • Callaway L.K.
      A review of blood pressure measurement in obese pregnant women.
      Thus, it can be recommended for use in pregnancy and may be particularly useful for accurate detection of blood pressure in high-risk women with pre-eclampsia, where impaired accuracy of other automated devices at higher blood pressures mean that they may underestimate the true blood pressure.
      • Nathan H.L.
      • de Greeff A.
      • Hezelgrave N.
      • Chappell L.
      • Shennan A.
      An accurate semi-automated oscillometric blood pressure (BP) device for use in pregnancy in a low- and middle-income country population: the Microlife 3AS1-2.
      It can be used with both small and large cuff sizes.
      In addition, the Cradle VSA has been specifically designed for use in low-resource settings, where healthcare workers have limited access to accurate vital signs measuring devices that are suitable for their environment. Over 20 000 such devices have been rolled out in over 20 low- and middle-income countries recently. The device is low cost, easy to use, has low power requirements and can be charged using a standard mobile phone charger. It is also robust and remains very accurate, even at extremes of temperature and humidity.
      • Nathan H.L.
      • de Greeff A.
      • Hezelgrave N.
      • Chappell L.
      • Shennan A.
      An accurate semi-automated oscillometric blood pressure (BP) device for use in pregnancy in a low- and middle-income country population: the Microlife 3AS1-2.
      Its integrated traffic light early warning system can identify women who are hypertensive and at increased risk of complications, and who thus require referral and transfer to higher level care.
      • Nathan H.L.
      • Seed P.T.
      • Hezelgrave N.L.
      • et al.
      Early warning system hypertension thresholds to predict adverse outcomes in pre-eclampsia: a prospective cohort study.
      The device’s validation in pregnant women with low blood pressure means that it may also improve the detection of shock, secondary to obstetric haemorrhage or sepsis, particularly in a low-resource setting.
      • Nathan H.L.
      • De Greef A.
      • Hezelgrave N.
      • Chappell L.
      • Shennan A.
      Accuracy validation of the microlife 3AS1-2 blood pressure device in an African pregnant population with low blood pressure.
      The Cradle VSA device is the cheapest and most accurate blood pressure device available for use in pregnancy and has been recognised as one of the top thirty high impact innovations in global health.
      • Nathan H.L.
      • Vousden N.
      • Lawley E.
      • et al.
      Development and evaluation of a novel Vital Signs Alert device for use in pregnancy in low-resource settings.
      A discussion regarding blood pressure measurement in pregnant women would, therefore, not be complete without mention of this innovative device that has the potential to dramatically improve both maternal and neonatal outcomes around the world.

      References

        • Eley V.A.
        • Christensen R.
        • Kumar S.
        • Callaway L.K.
        A review of blood pressure measurement in obese pregnant women.
        Int J Obstet Anesth. 2018; 35: 64-74
        • Nathan H.L.
        • de Greeff A.
        • Hezelgrave N.
        • Chappell L.
        • Shennan A.
        An accurate semi-automated oscillometric blood pressure (BP) device for use in pregnancy in a low- and middle-income country population: the Microlife 3AS1-2.
        Blood Press Monit. 2014; 20: 52-55
        • Nathan H.L.
        • Seed P.T.
        • Hezelgrave N.L.
        • et al.
        Early warning system hypertension thresholds to predict adverse outcomes in pre-eclampsia: a prospective cohort study.
        Pregnancy Hypertens. 2018; 12: 183-188
        • Nathan H.L.
        • De Greef A.
        • Hezelgrave N.
        • Chappell L.
        • Shennan A.
        Accuracy validation of the microlife 3AS1-2 blood pressure device in an African pregnant population with low blood pressure.
        Blood Press Monit. 2015; 20: 299-302
        • Nathan H.L.
        • Vousden N.
        • Lawley E.
        • et al.
        Development and evaluation of a novel Vital Signs Alert device for use in pregnancy in low-resource settings.
        BMJ Innovations. 2018; 4: 192-198