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Blood pressure falls in the second trimester and then rises in the third trimester.
Blood pressure measurement is taken whilst the patient is in a semi-recumbent position. If the patient is lying then supine hypotension may result as the gravid uterus can impair venous return via the inferior vena cava. In about 5% of pregnant women a standard cuff (12 x 23 cm) will not encompass the arm of hypertensive pregnant mothers and therefore a large cuff should be used in these cases. The Korotkoff IV phase is recommended to be used as the measure of diastolic blood pressure in women by the World Health Organisation. The argument for this is because, in some pregnant women, the Korotkoff V phase is said to be heard at zero cuff pressure. However arecent studies have shown that this assertion is unfounded and suggest that Korotkoff V should be measured as the diastolic pressure in pregnancy (1,2). The use of Korotkoff V for recording diastolic pressure is recommended by the concensus report from the United States National Heart, Lung and Blood Institute.
Summary points about measuring blood pressure in pregnancy
Ambulatory blood pressure monitoring (ABPM):
Hypertension in pregnancy and pre-eclampsia are discussed in the menu items below.
Reference:
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