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.