MedWire News: Ambulatory blood pressure monitoring (ABPM) could help identify women with early-onset severe pre-eclampsia who are most likely to require early delivery, say researchers.

They found that the combination of mean diastolic blood pressure (DBP) and day-night blood pressure difference (DND) "seems to be of prognostic significance."

Sphygmanometry remains the gold standard method for monitoring blood pressure, but has shortcomings that may affect its accuracy during pregnancy.

To assess the value of ABPM, Daniel Steyn (Tygerberg Hospital and the University of Stellenbosch, South Africa) and co-workers studied 44 women presenting with severe pre-eclampsia between 28 and 34 weeks' gestation, who they managed expectantly for 8 days.

They measured the women's blood pressure every 30 minutes with an automated monitor for 24-hour periods on alternate days.

Results revealed that DND decreased significantly with increasing mean diastolic blood pressure (DBP).

Women classified as having "normal" DND and mean DBP had fewer cesareans and significantly longer gestations than other women, with only one delivery before 32 weeks' gestation, the researchers report. Cesarean rates were also reduced in women with normal DND and mean DNP, although the difference did not reach statistical significance.

Three of the five cases of abruptioplacentae occurred in the 10 patients in whom mean DBP and DND were both "abnormal."

Steyn et al say the combination of mean DBP and DND "could be particularly valuable in settings with limited neonatal intensive care facilities where expectant management of early-onset severe pre-eclampsia offers the best chance of neonatal survival."

Journal abstract