Blood pressure control

Blood pressure should be measured frequently (at least every 15 min). Automated sphygmomanometers can be used to facilitate this, or alternatively intra-arterial readings can be assessed via a peripheral arterial pressure transducer. As non-invasive measurements are obtained principally by oscillometric blood pressure devices, which underestimate blood pressure in pre-eclampsia [20,36], significant changes in blood pressure should be confirmed using mercury sphygmomanometry. Some devices are now accurate, and only those specifically assessed for accuracy in pre-eclampsia should be purchased in the future [37]. On an individual patient basis the accuracy of any device used should be established against an observer using standard sphygmomanometry, preferably with a mercury sphygmomanometer. Mean arterial pressures (MAP) are generally used to guide management in protocols. Antihypertensive therapy should be instigated when the MAP is >125 mmHg, or urgently if >140 mmHg as above this cerebral autoregulation of pressure is not reliable. Either hydrallazine or labetalol can be used as a first line treatment, although labetalol is favoured [38]. As these are important emergency measures in preventing stroke, clinicians involved in the management of severe pre-eclampsia should be familiar with treatment regimes. Some protocols advocate infusing a colloid to protect the uteroplacental circulation if the baby is undelivered. This should be done with caution, and careful consideration to the impact of the overall fluid management, and preferably under central venous pressure (CVP) surveillance.

Fig. 25.4 Maternal mortality 1985-2002: immediate hypertensive deaths.

□ intracerebral haemorrage

85-87 88-90 91-93 94-96 97-99 00-02 Year

□ intracerebral haemorrage

85-87 88-90 91-93 94-96 97-99 00-02 Year

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Blood Pressure Health

Blood Pressure Health

Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

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