Objectives To determine the prevalence of white coat hypertension and white coat effect among hypertensive pregnant women and to assess whether the presence of a significant white coat effect was associated with adver...
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Objectives To determine the prevalence of white coat hypertension and white coat effect among hypertensive pregnant women and to assess whether the presence of a significant white coat effect was associated with adverse pregnancy outcome when clinical management was based upon standard sphygmomanometric blood pressure recordings. Design Prospective blinded studies assessing the presence of a white coat effect. Setting Antenatal ward and pregnancy day assessment unit of St George Hospital, a teaching hospital in Sydney, Australia. Population One hundred and twenty-one hypertensive pregnant women in the second half of their pregnancy admitted to hospital or the day assessment unit for management of their hypertensive disorders. Methods Routine sphygmomanometric blood pressures were recorded by midwives in the ward or day assessment unit and awake blood pressure recordings were averaged. These blood pressures were compared with average awake blood pressures recorded by ambulatory blood pressure monitor (ABPM) (Spacelabs 90207, Seattle, Washington, USA). White coat hypertension was defined as an average sphygmomanometer blood pressure greater than or equal to 140 mmHg systolic and/or greater than or equal to 90 mmHg diastolic with awake ABPM average blood pressure within the normal range for ABPM-derived blood pressures in pregnancy, according to gestation. White coat effect was the difference between average sphygmomanometer blood pressure and average awake ABPM-derived blood pressure. All clinical management was based upon routine sphygmomanometer recordings and clinicians were blinded to ABPM data. Main outcome measures Prevalence of white coat hypertension and white coat effect;maternal and fetal outcomes in those with and without a white coat effect of greater than or equal to 20 mmHg systolic and/or greater than or equal to 10 mmHg diastolic. Results Systolic and diastolic white coat hypertension were present in only 3.2% and 4.2% of the group, respectively. A sys
Women in developing countries are dying from simple preventable conditions but what impact can the procedures collectively called antenatal care have in reducing maternal mortality and morbidity? More importantly what...
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Women in developing countries are dying from simple preventable conditions but what impact can the procedures collectively called antenatal care have in reducing maternal mortality and morbidity? More importantly what is antenatal care? This review found that questions have been raised about the impact of antenatal care (specifically on maternal mortality) since its inception in developed countries, and that although the questions continue to be asked there is very little research trying to find answers. Many antenatal procedures are essentially screening tests yet it was found that there were very few results showing sensitivity and specificity, and that they rarely complied with the established criteria for the effectiveness of a screening test. The acknowledged gold standard measurement of effectiveness is the randomized controlled trial, yet the only results available referred to nutritional supplementation. This service of flawed methodology has been exported to developing countries and is being promoted by WHO and other agencies. This paper argues that there is insufficient evidence to reach a firm decision about the effectiveness of antenatal care, yet there is sufficient evidence to cast doubt on the possible effect of antenatal care. Research is urgently required in order to identify those procedures which aught to be included in the antenatal process. In the final analysis the greatest impact will be achieved by developing a domiciliary midwifery service supported by appropriate local efficient obstetric services. That this domiciliary service should provide care for women in pregnancy is not disputed but the specific nature of this care needs considerable clarification.
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