Rhodes, Catharine Alison (2009)
M.Phil. thesis, University of Birmingham.
This thesis focuses on outcomes in hypertension in pregnancy, and the role of ambulatory blood pressure monitoring (ABPM). Overviews of blood pressure measurement and hypertension in pregnancy are followed by discussion of ABPM in non-pregnant and pregnant individuals. A literature review of research in ABPM in pregnancy is presented, revealing good prediction of certain outcomes. ABPM is recommended in chronic hypertension, identifying white coat hypertension and targeting intervention appropriately in pregnancy. An extensive database of hypertensive pregnancies is then analysed to assess outcomes in a local multi-ethnic population. Women with chronic hypertension are examined separately. Very high rates of stillbirth are evident, especially in women of Asian and Black ethnicity with growth-restricted babies. ABPM is then compared with sphygmomanometer measurements in 100 women using regression analysis, assessing prediction of perinatal outcomes. ABPM is superior in predicting low birth weight, prematurity and proteinuria. Finally, the first randomized controlled trial (RCT) of ABPM in pregnancy is presented. Hypertensive pregnant women were randomized to revealed or concealed ABPM results. Fewer women in the ‘revealed’ group underwent induction of labour for hypertension. However, the reduction in overall rates of induction did not reach significance. Patient satisfaction was high. Randomized trials of ABPM in pregnancy are viable. Further RCTs particularly in chronic hypertensives are recommended.
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