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First Trimester Mean Arterial Pressure Measured Manually Versus Using an Automated Device and the Prediction of Preeclampsia: A Case-Cohort Study

  • Maxime Côté
    Affiliations
    Department of Gynecology, Obstetrics and Reproduction, Faculty of Medicine, Université Laval, Québec City, QC
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  • Amélie Boutin
    Affiliations
    Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, BC
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  • Cédric Gasse
    Affiliations
    Reproduction, Mother and Child Health Unit, Centre Hospitalier Universitaire de Québec - Université Laval Research Center, Université Laval, Québec City, QC

    Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Québec City, QC
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  • Suzanne Demers
    Affiliations
    Department of Gynecology, Obstetrics and Reproduction, Faculty of Medicine, Université Laval, Québec City, QC

    Reproduction, Mother and Child Health Unit, Centre Hospitalier Universitaire de Québec - Université Laval Research Center, Université Laval, Québec City, QC
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  • Emmanuel Bujold
    Correspondence
    Corresponding author: Dr. Emmanuel Bujold, Department of Gynecology, Obstetrics and Reproduction, Faculty of Medicine, Université Laval; Reproduction, Mother and Child Health Unit, Centre Hospitalier Universitaire de Québec - Université Laval Research Center, Université Laval, Québec City, QC.
    Affiliations
    Department of Gynecology, Obstetrics and Reproduction, Faculty of Medicine, Université Laval, Québec City, QC

    Reproduction, Mother and Child Health Unit, Centre Hospitalier Universitaire de Québec - Université Laval Research Center, Université Laval, Québec City, QC
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Published:October 31, 2019DOI:https://doi.org/10.1016/j.jogc.2019.06.017

      Abstract

      Objective

      First trimester mean arterial blood pressure (MAP) can be used to predict preeclampsia. This study aimed to compare the performance of first trimester MAP measured with an automated device using a standardized technique versus MAP taken manually in a typical clinical setting.

      Methods

      A case-cohort study niched into a prospective cohort of pregnant women recruited at 11–14 weeks was performed. MAP was measured with an automated device on both arms until stability was reached. These results were compared with the MAP measured with a manual device at the closest medical visit (between 10 and 15 weeks gestation) and noted in the medical charts. Receiver-operator characteristics curve analyses were used to estimate the predictive values of MAP measured by both techniques.

      Results

      Forty-one women with preeclampsia and 167 control patients were used for the comparisons. MAP measured with an automated device decreased significantly between 11 and 14 weeks gestation (P < 0.001). Moreover, MAP measured with an automated device was a better predictor of preeclampsia (area under the curve 0.70; 95% confidence interval 0.61–0.79) than MAP measured with a manual device in a clinical setting (area under the curve 0.60; 95% confidence interval 0.50–0.70). Taken alone, MAP measured with an automated device was associated with a detection rate of preeclampsia of 34%, for a false-positive rate of 10%.

      Conclusion

      First trimester MAP can predict preeclampsia. This study demonstrated that MAP measured with an automated device using a standardized technique is a better predictor than MAP measured with a manual device.

      Résumé

      Objectif

      La pression artérielle moyenne (PAM) du premier trimestre peut servir à prédire la pré-éclampsie. Cette étude visait à comparer la précision de la PAM du premier trimestre mesurée par un appareil automatisé au moyen d'une technique standardisée et la PAM prise manuellement dans un milieu clinique habituel.

      Méthodologie

      Une étude de cohorte intégrée à une cohorte prospective de femmes enceintes recrutées entre 11 et 14 semaines de grossesse a été réalisée. La PAM a été mesurée par un appareil automatisé sur les deux bras jusqu’à l'atteinte de la stabilité. Les résultats ont été comparés avec la PAM mesurée au moyen d'un dispositif manuel lors du rendez-vous médical le plus près (entre 10 et 15 semaines de grossesse); le tout a été consigné au dossier médical de chaque patiente. Les analyses des courbes receveuse-opérateur ont été utilisées pour estimer les valeurs prédictives des PAM issues des deux techniques.

      Résultats

      Pour réaliser la comparaison, on a utilisé les résultats de 41 femmes atteintes de pré-éclampsie et de 167 témoins. Entre 11 et 14 semaines de grossesse, la PAM mesurée par un appareil automatisé a significativement diminué (P < 0,001). Qui plus est, la PAM mesurée par un appareil automatisé a été un meilleur indicateur de la pré-éclampsie (zone sous la courbe : 0,70; intervalle de confiance de 95 % : 0,61–0,79) que la PAM mesurée manuellement en milieu clinique (zone sous la courbe : 0,60; intervalle de confiance de 95 % : 0,50–0,70). Envisagée seule, la PAM mesurée par un appareil automatisé a été liée à un taux de 34 % pour la détection de la pré-éclampsie et à un taux de faux positifs de 10 %.

      Conclusion

      La PAM du premier trimestre peut prédire la pré-éclampsie. Cette étude a démontré que la PAM mesurée par un appareil automatisé au moyen d'une technique standardisée est un meilleur prédicteur que la PAM mesurée au moyen d'un dispositif manuel.

      Key Words

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