Home monitoring programs

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An alternative to daycare is monitoring in the home environment. This involves variations of home self-monitoring and home visits by midwives or nurse (Leung etal., 1998). This can utilize the increasingly available home blood pressure monitors and self-testing of urine using stix (Barton et al., 1994; Waugh et al., 2001). Although concerns have been expressed about the difficulty of antepartum self-testing and compliance to medical recommendations, particularly in certain at-risk groups (Barton et al., 1997, 2002), the overall benefits of reduced hospitalization with no change in outcome appears uniform (Barton et al., 1994; Crowther et al., 1992;

Leung et al., 1998; Mathews et al., 1971; Waugh et al., 2001).

Blood pressure recordings can be carried out by the women themselves. A study by Waugh et al. (2001) recruited 72 women from the antenatal hypertension clinic in a university teaching hospital. All were high-risk for pre-eclampsia and were asked to measure and record their blood pressure three times per day at home using a validated blood pressure device with an internal memory. 979 measurements were taken, and of these only 2.9% appeared to be inaccurate. These were restricted to three women who admitted family members using the device. The true nonconcordance was therefore 1.4%. The authors concluded that blood pressure recording taken and documented by high-risk women at home were accurate. This allows a method of taking more frequent measurements without the inconvenience of additional visits to hospital and may therefore lead to the earlier detection of progression of pre-eclampsia (Waugh et al., 2001).

There have also been studies into the use of 24 h ambulatory blood pressure monitoring pregnancy, which, if successful will get round the problem of ''white coat'' hypertension. Brown et al. (1998) demonstrated that normal ambulatory blood pressure in pregnancy showing the expected rise as pregnancy progresses and diurnal variations. Awake measurements are higher than ''clinic'' measurements recorded under relaxed conditions. It was felt that outpatient ambulatory blood pressure determination may improve the predictive value of blood pressure measurements (Biswas et al., 1997; Penny et al., 1998). However, further studies suggest that the differences seen are small and give no benefit over traditional screening methods (Higgins et al., 1997). A recent Cochrane review concluded that there is no randomized controlled evidence to support the use of ambulatory blood pressure monitoring during pregnancy. Further studies with adequate design and sample sizes are required to establish the usefulness of ambulatory blood pressure monitoring for those at risk of the disease and also in those with established hypertension. They also commented that these trials should not only evaluate clinical outcomes, but also the use of healthcare resources and the women's views (Bergel et al., 2002).

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