【Cochrane简语概要】妊娠期间在不同环境和技术下测量血压是否有助于改善妇女和婴儿的妊娠结局？

本系统综述的问题

在妊娠期间定期进行血压测量对高血压的诊断和治疗至关重要。血压的测量可以在各种环境下进行（例如在诊所或在家中自我测量），也可以使用不同的技术（例如根据不同的血流声进行测量）。它们可能对高血压的诊断和检测，以及降低妇女和婴儿患严重疾病或死亡的风险有不同的影响。

研究的重要性

如果未能及时发现和管理妊娠期高血压，可能会发生严重的并发症。需要进行此综述以确定这些检测环境和技术对孕妇及其胎儿的益处和风险。

我们发现的证据

我们于2020年4月检索了来自随机对照试验的证据，确认了3项研究（共包含536,607名女性）。总的来说，由于其中两项研究的规模较小，另一项研究设计受限，我们无法确定研究的结果。

一项英国研究（154名女性）比较了血压检测环境：在家进行自我检测和临床上的常规检测。另外两项研究比较了血压检测技术：一项澳大利亚研究（220名女性）比较了通过两种不同的血流声以确定舒张压（最低值）；另一项跨越了非洲、印度及海地的研究（536233例分娩案例）比较了引进半自动血压监测仪及教育套餐（CRADLE干预）和常规检测。

没有一项研究检测了高血压、出生前入院的妇女人数、婴儿在新生儿病房中所待时间或在呼吸上获得的额外帮助。

在家进行自我血压测量与临床上常规检测对比

与常规护理相比，自我血压检测可能导致更多妇女被诊断为先兆子痫，但证据尚不确定。

我们不确定自我血压监测是否会增加死产、婴儿出生后死亡、妇女过早生产或入住重症监护室的可能性。

与常规护理相比，自我血压监测对孕妇进行人工引产的可能性几乎没有影响。

与常规护理相比，自我血压监测可能会导致新生儿入院人数略微增加。

这项试验中没有孕产妇死亡，也没有报告出生前或出生后不久的婴儿死亡人数。

根据不同的血流声测量血压——比较通过Korotkoff IV期（K4，柔和，沉闷的声音） 和Korotkoff V期（K5，声音消失时）来测量舒张压

使用K4或K5在诊断先兆子痫上可能几乎没有差别；但证据尚不确定。

我们不确定其对出生前或出生后不久的婴儿死亡是否有所影响。

这项试验中没有孕产妇死亡，也没有报告入院接受重症监护的妇女人数，需要引产的妇女人数、以及发生早产、死产、婴儿出生后死亡或新生儿住院的人数。

CRADLE干预（半自动血压监测仪及教育套餐） 与常规护理相比

使用CRADLE血压监护仪对孕产妇死亡的风险可能几乎没有影响。

该试验没有报告发生先兆子痫、需要人工引产或发生早产的妇女人数和婴儿死亡（出生前和出生后）或需要住院的人数。由于在这项试验中仅有一个亚组报道了入院接受重症监护的妇女人数以及发生死产和婴儿出生后死亡的人数，因此我们不纳入这些结果。

这意味着什么？

需要更多的证据来说明自我监测血压对高血压的孕妇是否有益，因为这方面的研究很少。

目前医疗实践中采用K5（无血流声）测量高血压孕妇的舒张压。

这项使用CRADLE装置监测妊娠期血压的试验在设计上存在局限性，因此我们不能确定其益处。

（图片来源于pixabay.com）

结论: 

由于证据仅限于一项可行性研究，因此自我监测血压对高血压妊娠的益处（如果有的话）仍然不确定。目前实践中采用K5测量妊娠高血压孕妇的舒张压。由于试验研究设计的局限性和不稳定性，使用CRADLE设备测量孕妇血压的好处（如果有的话）仍然不确定。

译者：曾梦遥，复旦大学博士生；审校：张晓雯，北京中医药大学循证医学中心；编辑排版：郑偌祥、张晓雯，北京中医药大学循证医学中心

相关文章链接

【Cochrane Plain Language Summary】Do different settings and techniques for measuring blood pressure during pregnancy help to improve outcomes for women and babies?

What is the issue?

Regular blood pressure (BP) measurements are crucial during pregnancy for the diagnosis and management of high BP. BP can be measured in various settings (e.g. self-measurement at home versus in clinic) and using different techniques (e.g. measurement based on different blood flow sounds). They may have different effects on diagnosing and monitoring high BP, and reducing the risk of serious illness or death in both woman and baby.

Why is this important?

If high BP in pregnancy is not detected and managed in a timely fashion, serious complications can develop. This review is needed to establish the benefits and risks of these settings and techniques for women and their babies.

What evidence did we find?

We searched for evidence from randomised controlled trials in April 2020, and identified three studies (involving 536,607 women). Overall, the studies were conducted in such a way that we are not certain of the findings, mainly due to the small size of two of the studies and the design of the other.

One study (154 women) compared BP settings in the UK: self-monitoring at home versus usual measurement in clinic. The other two studies compared BP techniques: one (220 women) compared two different blood flow sounds to determine diastolic BP (the bottom number) in Australia, and the other (536,233 deliveries) investigated the introduction of a semi-automated BP monitor and an education package (CRADLE intervention) compared with usual care across Africa, India and Haiti.

None of the studies measured high BP, the number of women admitted to hospital before birth, how long babies stayed in the neonatal unit, or what extra help babies received for their breathing.

Self-measurement of BP at home compared with usual BP measurement in clinic

Self-monitoring BP may lead to more women being diagnosed with pre-eclampsia compared with usual care but the evidence is uncertain.

We are uncertain if self-monitoring BP increases the likelihood of stillbirth, baby deaths (after birth), women giving birth early, or women admitted to the intensive care unit.

Self-monitoring BP may have little to no effect on the likelihood of women having their labour induced compared with usual care.

Self-monitoring BP may lead to slightly more newborns being admitted to a neonatal unit compared with usual care.

This trial had no maternal deaths, and did not report the number of baby deaths, before or shortly after birth.

Measuring BP using different blood flow sounds - Korotkoff phase IV (K4, softer, muffled sound) compared with Korotkoff phase V (K5, when the sound disappears) to measure diastolic BP

There may be little to no difference between using K4 or K5 to diagnose pre-eclampsia; the evidence is uncertain.

We are uncertain if there is an effect on baby deaths, before or shortly after birth.

This trial had no maternal deaths, and did not report the number of women admitted to intensive care, women who needed their labour induced, women giving birth early, stillbirths, baby deaths (after birth), or babies admitted to the neonatal unit.

CRADLE intervention (semi-automated BP monitor and an education package) compared with usual care

The CRADLE BP monitor may make little or no difference to the risk of maternal death.

The trial did not report the number of women with pre-eclampsia, women who needed their labour induced, women giving birth early, baby deaths (before and after birth), or the number of babies admitted to the neonatal unit. The number of women admitted to intensive care, stillbirths, and baby deaths (after birth) were only reported for a subgroup of women in this trial, so we did not include these results.

What does this mean?

More evidence is needed on whether self-monitoring BP in pregnant women with high BP is beneficial, because the study exploring this was small.

Current practice of using K5 (no blood flow sound) to measure diastolic BP is supported in pregnant women with high BP.

The trial using the CRADLE device to monitor BP in pregnancy had limitations in its design, and we are uncertain about its benefit.

Authors' conclusions: 

The benefit, if any, of self-monitoring BP in hypertensive pregnancies remains uncertain, as the evidence is limited to one feasibility study. Current practice of using K5 to measure diastolic BP is supported for women with pregnancy hypertension. The benefit, if any, of using the CRADLE device to measure BP in pregnancy remains uncertain, due to the limitations and instability of the trial study design.

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