Hypertension, Pregnancy-Induced
Conditions
Keywords
Blood pressure measurement, Conicity index, Mid arm circumference, Cuff size
Brief summary
Accurate blood pressure (BP) measurement is critical in peripartum care. The cuff and bladder sizes affects the accuracy of BP measurement. Current international BP measurement recommendations are based on mid-arm circumference (MAC). However, evidence have shown the discrepancies between these sizes, leading to inaccuracy of BP measurement. This study will measure arm and finger size of 300 parturients in third trimester to determine whether the MAC, finger measurement or body mass index (BMI) is the best clinical predictor for non-standard cuff sizes for BP measurement.
Detailed description
Accurate blood pressure (BP) measurement plays an important role in peripartum care as it is essential in detecting hypertensive disorders in pregnancy and medical decision making during the pregnancy. The cuff and bladder size have been highlighted as an important factor affecting the accuracy of BP measurement. Current international BP measurement recommendations are based on mid-arm circumference (MAC) assuming the arm is cylindrical in shape. However, evidence have shown a mismatch between these sizes, leading to BP overestimation or underestimation in obese patients. This is because the shape of the arm is a truncated cone instead of a cylinder, and the cuff will expand irregularly during inflation thus yielding inaccurate BP measurements. This is especially evident in Asian pregnant patients whereby no available guideline can recommend a suitable cuff for parturients with different MAC. Nexfin is a finger cuff device that can be a suitable alternative BP measurement device for such patients. In this study 300 parturients will be recruited in third trimester and undergoing nonemergent caesarean section in KKH. Patients' arm and finger sizes will be measured, and their user experience on current practices on BP measurement. The arm measurements will help to identify the proportion of women that may require non-standard cuff sizes for BP measurement. A conicity index will be determined whether the MAC, finger measurement or BMI is the best clinical predictor. The finger measurements will also help to determine the proportion of women that may require non-standard cuff sizes on the Nexfin device for BP measurement. The knowledge gathered in this pilot study will be used to design future studies in which the accuracy of Nexfin will be compared with standard BP measurement, which in turn will improve BP detection, subsequent patient monitoring and satisfaction.
Interventions
OTHERPhysical measurement
Parturients of gestational week \>= 32 weeks will have their arms and fingers measured to generate the conicity index.
OTHERCuff size fitting
Fit on arm cuff and finger cuff as selected by investigators based on the measurement.
Sponsors
KK Women's and Children's Hospital
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
FEMALE
Age
21 Years to 50 Years
Healthy volunteers
No
Inclusion criteria
* American Society of Anaesthesiologists physical status 1 or 2 (ASA 1 or 2) parturients at 32 or more weeks of gestation * Multiparous or nulliparous; * Age 21-50 years old; * Undergoing Caesarean section in our institution.
Exclusion criteria
* Emergent Caesarean section such that consent and measurements cannot be taken.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Arm length (Left, Right) | During antenatal visit (1-2 hours). One visit only | The distance (cm) between the tip of the acromion process to the tip of the olecranon process on the posterior aspect of the arm, with the elbow in the flexed position. |
| Mid Arm circumference (MAC)(Left, Right) | During antenatal visit (1-2 hours). One visit only | The circumference (cm) of the arm at the mid-point of the arm length as measured above, with the arm hanging by the side. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Proximal arm circumference (Left, Right) | During antenatal visit (1-2 hours). One visit only | Arm circumference (cm) of the arm measured at the axilla, with the arm hanging by the side. |
| Distal arm circumference (Left, Right) | During antenatal visit (1-2 hours). One visit only | The circumference (cm) at the elbow above the elbow crease, with the arm hanging by the side. |
| Finger circumference (Left, Right) | During antenatal visit (1-2 hours). One visit only | The circumference (cm) of the mid-point of the middle phalanx of the middle finger will be measured with the hands placed flat on a table. |
| Feedback on experiences of previous BP measurement | During antenatal visit (1-2 hours). One visit only | Participants will also respond to a three-point rating scale (Never, sometimes, always) about their experience of the procedures for previous BP measurement during the current pregnancy, with questions such as the length of time taken to obtain a reading, the need to change a cuff when taking BP, the need to take BP on the leg and whether the arm felt uncomfortable when taking blood pressure. |
Countries
Singapore
Contacts
PRINCIPAL_INVESTIGATORFarida Ithnin, MMED (Anaes)
KK Women's and Children's Hospital
Outcome results
None listed