Using a smartphone app to identify signs of pre-eclampsia and/or worsening blood pressure
Hypertensive disorders of pregnancy complicate 10% of pregnancies and can have serious consequences.
To explore the experiences of pregnant women with a history of hypertension using an innovative home blood pressure monitoring device.
A qualitative study using a grounded theory approach was undertaken. Data were collected through semi-structured interviews. Women were given a blood pressure machine to monitor their blood pressure daily. They inserted their blood pressure results on a smartphone app and answered questions for signs of pre-eclampsia. Participants were followed up every 2 weeks.
The results suggested that women wanted a holistic care pathway for the management of hypertension in pregnancy. Three subcategories (‘empowerment’, ‘comparison of care pathways’ and ‘continuity of care’) were also identified.
The traditional management of hypertension in pregnancy is not holistic. The home blood pressure service was accepted by women and incorporated elements of holistic care but more is required to meet the standard of care that women need.
Hypertensive disorders of pregnancy (HDP) are classified as gestational hypertension, pre-existing or chronic hypertension and pre-eclampsia. HDP complicate 10% of pregnancies and the incidence of pre-eclampsia is 2-8% (Steegers et al, 2010). Pre-eclampsia is associated with adverse maternal and fetal outcomes, such as eclampsia, stroke, renal and hepatic dysfunction, intrauterine growth restriction, premature birth and stillbirth (Tranquilli et al, 2014; Townsend et al, 2015). The resources required for the monitoring of developing pre-eclampsia have significant cost implications (Stevens et al, 2017); however, the majority of women do not actually develop pre-eclampsia (Villar et al, 2003).
Traditionally, in the UK, women attend their scheduled antenatal visits as per National Institute of Health and Care Excellence (NICE) (2018) recommendations. If they show signs of HDP, or have risk factors for developing HDP, they will have extra scheduled antenatal visits to monitor for the development of pre-eclampsia. These extra antenatal visits could be with their GP, midwife or a health professional from a day assessment unit and the structure of care varies from hospital to hospital. Despite this increased surveillance of blood pressure, pre-eclampsia can manifest between antenatal visits, and so the diagnosis can be delayed until the next scheduled antenatal check (Waugh et al, 2001). Therefore, the traditional pathway may fail to capture women who may develop pre-eclampsia until it is at an advanced stage.
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