MEASURING BLOOD PRESSURE AND PROTEINURIA WHAT IS THE

MEASURING BLOOD PRESSURE AND PROTEINURIA

WHAT IS THE POINT OF ANTENATAL CARE?

WHAT HAS CHANGED IN THE LAST 100 YEARS?

CAUSES OF DEATH IN THE UK TODAY

DEATHS FROM HYPERTENSIVE DISORDERS AROUND THE WORLD (20112013) 14% WHO (of 89, 000 deaths) 7. 4% US 2. 8% UK (6/ 214 deaths)

WE HAVE MADE SIGNIFICANT PROGRESS IN UK DEATHS FROM PREECLAMPSIA HAVE REDUCED DRAMATICALLY

PHYSIOLOGICAL CHANGES IN BLOOD PRESSURE

WHAT IS BLOOD PRESSURE ?

HISTORY OF HYPERTENSION William Harvey(1578– 1657), described the circulation of blood in his book "De motu cordis" Descriptions of hypertension as a disease from Thomas Young in 1808 and Richard Bright in 1836 First report of elevated blood pressure in a person without evidence of kidney disease was made by Frederick Akbar Mohamed (1849– 1884) Invention of the cuff-based sphygmomanometer by Scipione Riva-Rocci in 1896 In 1905, Nikolai Korotkoff improved the technique by describing the sounds that are heard when the artery is ausculated with a stethoscope while the sphygmomanometer cuff is deflated

MEASURING BP Automated blood pressure machine Validation? ? ? Myers et al 2011 BMJ Reinders et al 2005 BJOG

Nathan et al TOG 2015. Automated devices validated for use in pregnancy (including pre-eclampsia) OMRON MIT Elite OMRON MIT OMRON Hem 705 CP OMRON M 7 Microlife Watch. BP Home Microlife BP 3 BTO-A Microlife BP 3 AS 1 -2 Welch Allyn Spot Vital Signs Dinamap Pro. Care 400

HOW TO CHECK BP Measure the arm circumference Use the correct sized cuff Use a validated/calibrated device Do at the level of the heart Use Kortakoff V Discard first measurement and take average of 2/3

HISTORY OF URINALYSIS AND MEASUREMENTS 1797 Carl Friedrich Gartner conceptualised the idea of measuring components of urine 1797 William Cumberland Cruikshank described properties of urine by hearting 1850 Jules Maumene develops first test strips 1883 George Oliver markets urine test papers 1920 Fritz Feigl publishes technique of spot analysis 1964 Boehringer Mannheim launched first commercial test strips

PROTEINURIA- WHAT IS IT? Best measured as a spot urine sample At the bedside-dipstick urine In the laboratory as protein-creatinine ratio Dipstick only measures albumin

IMPORTANCE OF MIDSTREAM SAMPLE Clean catch

1. 2 Assessment of proteinuria in hypertensive disorders of pregnancy 1. 2. 1 Interpret proteinuria measurements for pregnant women in the context of a full clinical review of symptoms, signs and other investigations for pre-eclampsia. [2019] 1. 2. 2 Use an automated reagent-strip reading device for dipstick screening for proteinuria in pregnant women in secondary care settings. [2019] 1. 2. 3 If dipstick screening is positive (1+ or more), use albumin: creatinine ratio or protein: creatinine ratio to quantify proteinuria in pregnant women. [2019] 1. 2. 4 Do not use first morning urine void to quantify proteinuria in pregnant women. [2019]

1. 2. 5 Do not routinely use 24‑hour urine collection to quantify proteinuria in pregnant women. [2019] 1. 2. If using protein: creatinine ratio to quantify proteinuria in pregnant women: use 30 mg/mmol as a threshold for significant proteinuria if the result is 30 mg/mmol or above and there is still uncertainty about the diagnosis of pre-eclampsia, consider re‑testing on a new sample, alongside clinical review. [2019] 1. 2. 7 If using albumin: creatinine ratio as an alternative to protein: creatinine ratio to diagnose pre-eclampsia in pregnant women with https: //www. nice. org. uk/guidance/ng 133/chapter/recommendations %23 hypertension use 8 mg/mmol as a diagnostic threshold if the result is 8 mg/mmol or above and there is still uncertainty about the diagnosis of pre-eclampsia, consider re‑testing on a new sample, alongside clinical review. [2019]

PITFALLS FALSE POSITIVE OF PROTEINURIA Infection Exercise-strenuous-body building If blood in urine Very dilute urine

GUIDANCE Documentation is essential All women require a BP and urinalysis on each review Once PET confirmed do not need to repeat quantification of proteinuria However women with chronic kidney disease, risk of superimposed PET-serial PCR is helpful

IN SUMMARY Blood pressure and urinalysis are important during pregnancy Accurate measurement is required Regular follow-up and documentation is essential