¶ … Korotkoff Phase Should Be Used as the Endpoint for the Measurement of Diastolic Blood Pressure During Pregnancy
Literature Selection and Identification
Critical Appraisal of Selected Literature
Five Korotkoff Phases
Conducting System of Human Heart
Two of the most common complicating problems seen during pregnancy are the appearance of gestational diabetes and of hypertension. Both of these conditions are more likely to occur during late pregnancy and both generally abate in the postpartum period. Nevertheless, both of these conditions represent an increased risk for future development of disease. There is a lack of agreement among clinicians concerning the optimum blood pressure measurement device and inconsistencies in practice with regard to the method in which blood pressure is measured. Blood pressure is created by a number of physical forces related to the heart and blood vessels and regulated by hormones and other substances in the human body. The blood pressure measurement is an important clinical area because raised blood pressure in pregnancy may have relatively acute and potentially serious consequences; consequently, accurate measurements throughout the pregnancy are essential. The sounds produced by small amounts of blood passing through a blood pressure cuff are called Korotkoff sounds, after the physician who first used this method in the early 1900s, and five Korotkoff phases are described in adults. A review of the relevant and scholarly literature is followed by a critical review of selected studies to identify the most efficacious method of measuring blood pressure during pregnancy. The results of the research are followed by a discussion, conclusions and recommendations.
An Investigation as to which Korotkoff Phase Should Be Used as the Endpoint for the Measurement of Diastolic Blood Pressure During Pregnancy
Introduction/Background
Researchers in the field of family systems medicine have long recognized the association between psychosocial stressors and the onset of various illnesses and their exacerbation (McDaniel, 1992). Psychosocial distress has been implicated in the etiology and/or exacerbation of such conditions as chronic idiopathic prostatitis, somatization disorder, and adverse pregnancy outcomes (Langer et al., 1996). In an international study of medically unexplained physical symptoms, the World Health Organization concluded that psychosocial stress may be specifically responsible for many of the multiple, persistent, and medically unexplained somatic symptoms seen by primary care physicians across multiple cultures and populations (Isaac et al., 1995). Two of the most common complicating problems seen during pregnancy are the appearance of gestational diabetes (Freinkel, 1980, 1985) and of hypertension (National High Blood Pressure Education Program, 1990).
Hypertension has been linked to poor fetal development and ensuing perinatal death (Mansfield, 1986). In their study of pregnancy over 40 years, Horger and Smythe (1977) determined that fully one-third of their sample, black women of very high parity suffering from hypertension, accounted for two-thirds of all the perinatal deaths occurring during the study. These researchers attributed the link to placental malfunction. Other researchers have reported a link between hypertension and stillbirth, resulting from impaired placental circulation caused by placental infarction or abruption (Mansfield, 1986). Further, the prematurity rate rises with increased blood pressure, related both to premature labor and premature termination of the pregnancy; in addition, higher incidences of low birthweight have been reported among hypertensive patients by researchers in the Collaborative Perinatal Project (Mansfield, 1986).
Both gestational diabetes and hypertension are more likely to occur during late pregnancy and both generally abate in the postpartum period. Nevertheless, both of these conditions represent an increased risk for future development of disease (Baum, McCabe, & Schneiderman, 1992). The course of both of these conditions is such that both may be attributed to arising as a consequence of the progressive insulin resistance characteristic of pregnancy that abates postpartum, but may have revealed an underlying predisposition to subsequent disease development. However, today, there is a lack of agreement among clinicians concerning the optimum blood pressure measurement device and inconsistencies in practice with regard to the method in which blood pressure is measured. The blood pressure measurement is an important clinical area because raised blood pressure in pregnancy may have relatively acute and potentially serious consequences; consequently, accurate measurements during pregnancies are essential. The precise definition of the research question/hypothesis is presented below clarifying the explicit link to the identified clinical area of inquiry.
Statement of Problem
In the United States, 50 million people are thought to have high blood pressure; about half are receiving treatment and half...
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