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Sarah Cordey

on 19 February 2015

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Transcript of Statistics

Thank You!
The Numbers
Antenatal Care

In women with chronic hypertension, schedule additional antenatal consultations based on
the individual needs of the woman and her baby.
(NICE, Hypertension in Pregnancy)

Ambulatory BP Monitoring
What is it?

Why is is useful?

What does the evidence say?
Quality of Measurement
RCOG guidance...

Ambulatory versus conventional methods for monitoring blood pressure during pregnancy - the cochrane library - bergel - wiley online library Retrieved from http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001231/abstract
Brown, C., & Garovic, V. (2014). Drug treatment of hypertension in pregnancy. Drugs, 74(3), 283-296. doi:10.1007/s40265-014-0187-7
Brown, M. A. (2014). Is there a role for ambulatory blood pressure monitoring in pregnancy? Clinical & Experimental Pharmacology & Physiology, 41(1), 16-21.
Duley, L., Henderson-Smart, D. J., Meher, S., & King, J. F. (2007). Antiplatelet agents for preventing pre-eclampsia and its complications The Cochrane Database of Systematic Reviews, (2)(2), CD004659. doi:10.1002/14651858.CD004659.pub2 [doi]
Gillon, T. E. R., Pels, A., von Dadelszen, P., MacDonell, K., & Magee, L. A. (2014). Hypertensive disorders of pregnancy: A systematic review of international clinical practice guidelines Public Library of Science. doi:10.1371/journal.pone.0113715
Hypertension in pregnancy | guidance and guidelines | NICE Retrieved from http://www.nice.org.uk/guidance/CG107
Pre-eclampsia community (precog) guidelines » action on pre-eclampsia Retrieved from http://action-on-pre-eclampsia.org.uk/professional-area/precog/
Valler-Jones, T., & Wedgbury, K. (2005). Clinical skills. measuring blood pressure using the mercury sphygmomanometer. British Journal of Nursing, 14(3), 145-150.

The Guidelines
Sarah Cordey
Hypertension in pregnancy
Significant decrease in the maternal mortality rate from pre-eclampsia and eclampsia – now the lowest ever rate
0.38 per 100,000 maternities


CLASP trial, 1994

Duley, 2007

Cochrane Review of aspirin use
Hypertensive disorders of pregnancy (HDPs) are common, with most articles quoting figures of 6–8% of all pregnancies... Although other sources suggest that pre-eclampsia affects 10-15% of pregnancies in the UK (Action for Pre-Eclampsia, 2014).


• reduces the overall risk of developing severe pre-eclampsia by about 12 per cent – a reduction so small in statistical terms that it could have been due to chance. However, when the
CLASP results were analysed together with those of all previous trials the combined evidence suggested that the treatment with low-dose → aspirin reduces the risk of severe pre-eclampsia by about one quarter;

• significantly reduces the risk of early-onset pre-eclampsia.

Found that...
Overall, the use of aspirin was associated with a reduction of
only 12%
in the incidence of proteinuric pre-eclampsia, which was
not significant.
Recommendation, based on...

"No evidence was found on when and how often blood pressure measurements should be taken... In a systematic review of RCTs comparing a reduced number of antenatal appointments with the standard number of antenatal appointments, no difference in the rates of pre-eclampsia were reported."

Bergel, 2002, Cochrane Review

"There is no randomised controlled trial evidence to support the use of ambulatory blood pressure monitoring during pregnancy. Randomized trials with adequate design and sample sizes are needed to evaluate the possible advantages and risks of ambulatory blood pressure monitoring during pregnancy, in particular in hypertensive pregnant women. These trials should evaluate not only clinical outcomes, but also use of health care resources and women's views."
Full transcript