Effect of positioning on blood pressure measurement in pregnancy

Abstract

Blood pressure is the key vital sign to detecting hypertensive disorders in pregnancy. The importance of taking blood pressure properly was recently underscored by the publication of updated ACC/AHA guidelines for measuring blood pressure in patients. However, the recommended position of seating with arms and back supported is not always feasible to achieve clinically, especially for inpatient women who are pregnant. Therefore, it is clinically important to understand the effects of alternative patient positioning on blood pressure measurements. We conducted a review of studies which considered patient position on the effect of blood pressure in pregnancy. This review demonstrates that clinically significant differences may occur based on patient positioning. Despite the small number of primary studies that include pregnant women, notable reductions in blood pressure measurements have been observed in the left lateral recumbent position, a common position during labor or during monitoring, in comparison to measurements taken in the supported seated position. Ultimately, these differences could affect the clinical management of patients and care should be taken to document and consider the position in which the reading was taken.

Keywords: Blood pressure measurement; Fowler's; Left lateral; Patient positioning; Pregnancy; Supine.

Figure 1.. Schematic of Literature Search

Literature searches identified 183 unique manuscripts for review. After reviewing articles based on the exclusion criteria, 9 articles were eligible for inclusion.

Figure 2.. Overall Effect of Position on Blood Pressure Measurements

Based on the reviewed literature, blood pressure readings are lowest in the left lateral position, followed by supine position, Fowler’s position, and are highest in the seated position, respectively. Consideration of these differences should be made in clinical decision making.