Data from: Effectiveness and safety of 1 vs 4 h blood pressure profile with clinical and laboratory assessment for the exclusion of gestational hypertension and pre-eclampsia: a retrospective study in a university affiliated maternity hospital

Objective: We asked whether 60 compared with 240 min observation is sufficiently informative and safe for pregnancy day assessment (PDAC) of suspected pre-eclampsia (PE). Design: A retrospective study of 209 pregnant women (475 PDAC assessments, 6 months) with routinely collected blood pressure (BP), symptom and laboratory information. We proposed a 60 min screening algorithm comprising: absence of symptoms, normal laboratory parameters and ≤1high-BP reading (systolic blood pressure, SBP 140 mm Hg or higher or diastolic blood pressure, DBP 90 mm Hg or higher). We also evaluated two less inclusive screening algorithms. We determined short-term outcomes (within 4 h): severe hypertension, proteinuric hypertension and pregnancy-induced hypertension, as well as long-term outcome: PE-related diagnoses up to the early puerperium. We assessed performance of alternate screening algorithms performance using 2×2 tables. Results: 1 in 3 women met all screen negative criteria at 1 h. Their risk of hypertension requiring treatment in the next 3 h was 1.8% and of failing to diagnose proteinuric hypertensive PE at 4 h was 5.1%. If BP triggers were 5 mm Hg lower, 1 in 6 women would be screen-negative of whom 1.1% subsequently develops treatment-requiring hypertension and 4.5% demonstrate short-term proteinuric hypertension. We present sensitivity, specificity, negative and positive likelihood ratios for alternate screening algorithms. Conclusions: We endorse further research into the safest screening test where women are considered for discharge after 60 min. Safety, patient and staff satisfaction should be assessed prospectively. Any screening test should be used in conjunction with good clinical care to minimise maternal and perinatal hazards of PE.研究目的：探讨相较于240分钟的观测时长，60分钟观测是否可为疑似子痫前期（pre-eclampsia, PE）患者的妊娠日间评估（pregnancy day assessment, PDAC）提供充足信息且具备临床安全性。 研究设计：本研究为一项纳入209名孕妇（共完成475次PDAC评估，随访周期为6个月）的回顾性研究，所纳入数据均为常规采集的血压（blood pressure, BP）、症状及实验室检查信息。本研究提出了一套时长60分钟的筛查算法，判定标准为：无相关临床症状、实验室参数正常，且仅出现≤1次高血压读数（收缩压systolic blood pressure, SBP≥140mmHg或舒张压diastolic blood pressure, DBP≥90mmHg）。此外，本研究还对另外两种限制更为严格的筛查算法进行了评估。我们明确了两类结局指标：短期结局（4小时内）包括需治疗的严重高血压、蛋白尿性高血压及妊娠高血压；长期结局则包括直至产褥早期的子痫前期相关诊断。我们采用2×2列联表评估不同筛查算法的性能表现。 研究结果：每3名孕妇中便有1名在1小时观测后符合全部筛查阴性标准。该类孕妇在后续3小时内出现需接受治疗的高血压的风险为1.8%，且在4小时时漏诊蛋白尿性子痫前期的概率为5.1%。若将血压触发阈值下调5mmHg，则每6名孕妇中便有1名被判定为筛查阴性，其中1.1%后续发展为需治疗的高血压，4.5%出现短期蛋白尿性高血压。本研究给出了不同筛查算法的灵敏度、特异度、阴性似然比及阳性似然比。 研究结论：我们支持开展进一步研究，以探索针对可在60分钟观测后准予出院的孕妇的最安全筛查方案。需前瞻性评估该筛查方案的安全性、患者及医护人员的满意度。任何筛查工具均应与优质临床护理相结合，以最大限度降低子痫前期对孕产妇及围产儿的健康危害。