Background Accurate blood pressure BP assessment is required for the prediction of preeclampsia and other disorders of placental function Mean arterial pressure MAP is one of multiple parameters used in the Tommys ID: 1048504
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1. Standardised Blood Pressure Measurement
2. BackgroundAccurate blood pressure (BP) assessment is required for the prediction of pre-eclampsia and other disorders of placental functionMean arterial pressure (MAP) is one of multiple parameters used in the Tommy’s app to calculate the risk of placental dysfunctionThe tool will automatically calculate the MAP when a user enters the diastolic and systolic measurements
3. TechniqueSit down for 5 minutes: Ensure women are seated comfortably with 2 feet flat on the ground for 5 minutes prior to BP measurement.(Crossing of legs may increase BP)Use a validated blood pressure monitor: Ensure the blood pressure monitor has been calibrated and is validated for use in pregnancy and pre-eclampsia (see slide 4). (Non-validated BP monitors can significantly underestimate BP in pregnancy)Measure Arm Circumference: Measure the mid upper arm circumference using a tape measure. Match the appropriate cuff size to the arm circumference.(If cuff too large - BP overestimated, if cuff too small - BP underestimated)No smoking or caffeine for 30 minutes: Women should refrain from smoking or consuming caffeine at least 30minutes prior to BP measurement.(Smoking and caffeine may increase BP)
4. Validated Monitors: for use in pregnancy and pre-eclampsia 1. Omron M79. Microlife Watch BP Home A BT2. Omron MIT10. Microlife Watch BP Home S3. Omron MIT Elite11. Microlife Cradle VSA4. Omron HEM-9210T12. Andon, iHealth Track5. Omron BP760N13. Dinamap ProCare 4006. Microlife Watch BP Home A14. A&D UM-1017. Microlife BP 3BTO-A15. Nissei DS-4008. Mircorlife BP 3AS1-216. Omron HEM907Hurrell, et al (2021)
5. Cuff PositionThe BP cuff should be positioned 2cms (two finger breadths) above the crease in armThis correct positioning ensures the cuff is in line with the woman’s heart.If cuff positioned above the heart, the MAP is underestimated. If cuff positioned below the heart, the MAP is overestimated.
6. Blood Pressure MeasurementSit with 2 feet flat on the groundUsing correct cuff sizePosition cuff 2cms above crease of arm, with the artery mark in line with the brachial arteryTake four BP measurements (20-30 second intervals)Use the 4th BP reading for the Tommy’s clinical decision toolInput the systolic and diastolic measurements and the tool will automatically calculate the MAPArtery MarkBrachial ArterySystolicDiastolic
7. Recording Blood Pressure 1. Click ‘Placental Function Assessment’2. Click ‘Run Placental Function Assessment’3. Enter Systolic and Diastolic readings
8. Further Information and ResourcesReferencesHurrell et al (2021) The assessment of blood pressure in pregnant women: pitfalls and novel approaches, AJOG.https://www.fetalmedicine.org/education/preeclampsia-screeningFor further information: www.rcog.org.uk/tommys www.