Postpartum-Specific Vital Sign Reference Ranges.


Journal

Obstetrics and gynecology
ISSN: 1873-233X
Titre abrégé: Obstet Gynecol
Pays: United States
ID NLM: 0401101

Informations de publication

Date de publication:
01 02 2021
Historique:
received: 03 08 2020
accepted: 22 10 2020
pubmed: 9 1 2021
medline: 17 4 2021
entrez: 8 1 2021
Statut: ppublish

Résumé

To estimate normal ranges for postpartum maternal vital signs. We conducted a multicenter prospective longitudinal cohort study in the United Kingdom. We recruited women before 20 weeks of gestation without significant comorbidities and with accurately dated singleton pregnancies. Women recorded their own blood pressure, heart rate, oxygen saturation and temperature daily for 2 weeks postpartum. Trained midwives measured participants' vital signs including respiratory rate around postpartum days 1, 7, and 14. From August 2012 to September 2016, we screened 4,279 pregnant women; 1,054 met eligibility criteria and chose to take part. Postpartum vital sign data were available for 909 women (86.2%). Median, or 50th centile (3rd-97th centile), systolic and diastolic blood pressures increased from the day of birth: 116 mm Hg (88-147) and 74 mm Hg (59-93) to a maximum median of 121 mm Hg (102-143) and 79 mm Hg (63-94) on days 5 and 6 postpartum, respectively, an increase of 5 mm Hg (95% CI 3-7) and 5 mm Hg (95% CI 4-6), respectively. Median (3rd-97th centile) systolic and diastolic blood pressure returned to 116 mm Hg (98-137) and 75 mm Hg (61-91) by day 14 postpartum. The median (3rd-97th centile) heart rate was highest on the day of birth, 84 beats per minute (bpm) (59-110) decreasing to a minimum of 75 bpm (55-101) 14 days postpartum. Oxygen saturation, respiratory rate, and temperature did not change in the 2 weeks postbirth. Median (3rd-97th centile) day-of-birth oxygen saturation was 96% (93-98). Median (3rd-97th centile) day-of-birth respiratory rate was 15 breaths per minute (10-22). Median (3rd-97th centile) day-of-birth temperature was 36.7°C (35.6-37.6). We present widely relevant, postpartum, day-specific reference ranges which may facilitate early detection of abnormal blood pressure, heart rate, respiratory rate, oxygen saturation and temperature during the puerperium. Our findings could inform construction of an evidence-based modified obstetric early warning system to better identify unwell postpartum women. ISRCTN, 10838017.

Identifiants

pubmed: 33417320
doi: 10.1097/AOG.0000000000004239
pii: 00006250-202102000-00015
pmc: PMC7813441
doi:

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

295-304

Subventions

Organisme : Department of Health
ID : DRF-2016-09-073
Pays : United Kingdom
Organisme : Department of Health
ID : RP-2014-05-019
Pays : United Kingdom

Informations de copyright

Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc.

Déclaration de conflit d'intérêts

Financial Disclosure Peter J. Watkinson and Lionel Tarassenko, Lucy Chappell and Marian Knight hold grants from the National Institute for Health Research (NIHR). Marian Knight is an NIHR Senior Investigator. Lucy Chappell is an NIHR Research Professor. Lauren J. Green, Lucy H. Mackillop, Lionel Tarassenko, Peter J. Watkinson, Jude Mossop, Clare Edwards, Jacqueline Birks and Dario Salvi receive funding from NIHR Biomedical Research Centre, Oxford. Lucy H. Mackillop works part-time for Sensyne Health. Peter J. Watkinson worked for Sensyne Health. Both have share options in Sensyne Health. Lise Loerup is currently an employee of Boston Consulting Group. Lionel Tarassenko is a nonexecutive Director of Sensyne Health and holds share options in the company, and he is a nonexecutive Director of Oxehealth and holds shares in the company. Sensyne Health markets the System for Electronic Notification and Documentation, which allows recording of adult vital signs and early warning score calculation. It also markets an application for gestational diabetes management. Oxehealth markets a system to provide contact-free heart and breathing rate monitoring. Neither company had any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The other authors did not report any potential conflicts of interest.

Références

Creanga AA, Syverson C, Seed K, Callaghan WM, Author OG. Pregnancy-related mortality in the United States, 2011-2013 HHS public access author manuscript. Obstet Gynecol 2017;130:366–73. doi: 10.1097/AOG.0000000000002114
doi: 10.1097/AOG.0000000000002114
Knight M, Bunch K, Tuffnell D, Shakespeare J, Kotnis R, Kenyon S, et al. Saving lives, improving mothers' care. Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2015-17. Accessed December 11, 2020. https://www.npeu.ox.ac.uk/assets/downloads/mbrrace-uk/reports/MBRRACE-UK%20Maternal%20Report%202019%20-%20WEB%20VERSION.pdf
Matthews M, Von Xylander S, Jelka Z. WHO technical consultation on postpartum and postnatal care. Accessed December 11, 2020. https://apps.who.int/iris/bitstream/handle/10665/70432/WHO_MPS_10.03_eng.pdf;jsessionid=A7AAB21B67476A93D95E70A3CA91DD1C?sequence=1
Knight M, Buch K, Tuffnell D, Jayakody H, Shakespeare J, Kotnis R, et al. Saving lives, improving mothers' care. Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2014-16. National Perinatal Epidemiology Unit, University of Oxford; 2018.
Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels J, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Heal 2014;2:e323–33. doi: 10.1016/S2214-109X(14)70227-X
doi: 10.1016/S2214-109X(14)70227-X
Loerup L, Pullon RM, Birks J, Fleming S, Mackillop LH, Gerry S, et al. Trends of blood pressure and heart rate in normal pregnancies: a systematic review and meta-analysis. BMC Med 2019;17:167. doi: 10.1186/s12916-019-1399-1
doi: 10.1186/s12916-019-1399-1
Halligan A, O'Brien E, O'Malley K, Mee F, Atkins N, Conroy R, et al. Twenty-four-hour ambulatory blood pressure measurement in a primigravid population. J Hypertens 1993;11:869–73. doi: 10.1097/00004872-199308000-00014
doi: 10.1097/00004872-199308000-00014
Blake MJ, Martin A, Manktelow BN, Armstrong C, Halligan AW, Panerai RB, et al. Changes in baroreceptor sensitivity for heart rate during normotensive pregnancy and the puerperium. Clin Sci 2000;98:259–68.
O'Donaghue K. Physiological changes in pregnancy. In: Baker P, Kenny L, editors. Obstetrics by ten teachers. 19th ed. CRC Press; 2011. p. 319.
Lo C, Taylor RS, Gamble G, McCowan L, North RA. Use of automated home blood pressure monitoring in pregnancy: is it safe? Am J Obstet Gynecol 2002;187:1321–8. doi: 10.1067/mob.2002.126847
doi: 10.1067/mob.2002.126847
Churchill D, Beevers DG. Differences between office and 24-hour ambulatory blood pressure measurement during pregnancy. Obstet Gynecol 1996;88:455–61. doi: 10.1016/0029-7844(96)00192-5
doi: 10.1016/0029-7844(96)00192-5
Mahendru AA, Everett TR, Wilkinson IB, Lees CC, McEniery CM. A longitudinal study of maternal cardiovascular function from preconception to the postpartum period. J Hypertens 2014;32:849–56. doi: 10.1097/HJH.0000000000000090
doi: 10.1097/HJH.0000000000000090
Rang S, van Montfrans GA, Wolf H. Serial hemodynamic measurement in normal pregnancy, preeclampsia, and intrauterine growth restriction. Am J Obstet Gynecol 2008;198:519.e1–9.
Grindheim G, Estensen ME, Langesaeter E, Rosseland LA, Toska K. Changes in blood pressure during healthy pregnancy: a longitudinal cohort study. J Hypertens 2012;30:342–50. doi: 10.1097/HJH.0b013e32834f0b1c
doi: 10.1097/HJH.0b013e32834f0b1c
Walters BNJ, Thompson ME, Lee A, De Swiet M. Blood pressure in the puerperium. Clin Sci 1986;71:589–94. doi: 10.1042/cs0710589
doi: 10.1042/cs0710589
Lewis G, editor. Saving mothers' lives. Reviewing maternal deaths to make motherhood safer - 2003-2005: the seventh report of the confidential enquiries into maternal deaths in the United Kingdom. CRC Press; 2007.
Department of Health. Irish maternity early warning system (IMEWS) V2 (NCEC national clinical guideline No.4 version 2). Accessed Oct 8, 2020. https://www.gov.ie/en/collection/517f60-irish-maternity-early-warning-system-imews-version-2/
Mhyre JM, D'Oria R, Hameed AB, Lappen JR, Holley SL, Hunter SK, et al. The maternal early warning criteria: a proposal from the national partnership for maternal safety. Obs Gynecol 2014;124:782–6. doi: 10.1097/AOG.0000000000000480
doi: 10.1097/AOG.0000000000000480
McGlennan AP, Sherratt K. Charting change on the labour ward. Anaesthesia 2013;68:338–41. doi: 10.1111/anae.12189
doi: 10.1111/anae.12189
Smith GB, Isaacs R, Andrews L, Wee MYK, van Teijlingen E, Bick DE, et al. Vital signs and other observations used to detect deterioration in pregnant women: an analysis of vital sign charts in consultant-led UK maternity units Obstetric vital signs charts. Int J Obstet Anesth 2017;30:44–51. doi: 10.1016/j.ijoa.2017.03.002
doi: 10.1016/j.ijoa.2017.03.002
Isaacs RA, Wee MYK, Bick DE, Beake S, Sheppard ZA, Thomas S, et al. A national survey of obstetric early warning systems in the United Kingdom: five years on. Anaesthesia 2014;69:687–92. doi: 10.1111/anae.12708
doi: 10.1111/anae.12708
Friedman AM. Maternal early warning systems. Obstet Gynecol Clin North Am 2015;42:289–98. doi: 10.1016/j.ogc.2015.01.006
doi: 10.1016/j.ogc.2015.01.006
Tarassenko L, Clifton DA, Pinsky MR, Hravnak MT, Woods JR, Watkinson PJ. Centile-based early warning scores derived from statistical distributions of vital signs. Resuscitation 2011;82:1013–8. doi: 10.1016/j.resuscitation.2011.03.006
doi: 10.1016/j.resuscitation.2011.03.006
Watkinson PJ, Pimentel MAF, Clifton DA, Tarassenko L. Manual centile-based early warning scores derived from statistical distributions of observational vital-sign data. Resuscitation 2018;129:55–60. doi: 10.1016/j.resuscitation.2018.06.003
doi: 10.1016/j.resuscitation.2018.06.003
Green LJ, Mackillop LH, Salvi D, Pullon RM, Loerup L, Tarassenko L, et al. Gestation-specific vital sign reference ranges in pregnancy. Obs Gynecol 2020;135:653–64. doi: 10.1097/AOG.0000000000003721
doi: 10.1097/AOG.0000000000003721
Kumar F, Kemp J, Edwards C, Pullon RM, Loerup L, Triantafyllidis A, et al. Pregnancy Physiology Pattern Prediction study (4P study): protocol of an observational cohort study collecting vital sign information to inform the development of an accurate centile-based obstetric early warning score. BMJ Open 2017;7:e016034. doi: 10.1136/bmjopen-2017-016034
doi: 10.1136/bmjopen-2017-016034
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Int J Surg 2014;12:1495–9. doi: 10.1016/j.ijsu.2014.07.013
doi: 10.1016/j.ijsu.2014.07.013
The INTERBIO-21st Consortium. INTERBIO-21st study protocol. Accessed Oct 8, 2020. www.interbio21.org.uk
Stirnemann J, Villar J, Salomon LJ, Ohuma E, Ruyan P, Altman DG, et al. International estimated fetal weight standards of the INTERGROWTH-21stProject. Ultrasound Obstet Gynecol 2017;49:478–86. doi: 10.1002/uog.17347
doi: 10.1002/uog.17347
American Society of Anesthesiologists. ASA physical status classification system. Accessed Oct 8, 2020. https://www.asahq.org/standards-and-guidelines/asa-physical-status-classification-system
De Onis M. WHO child growth standards based on length/height, weight and age. Acta Paediatr Int J Paediatr 2006;95(suppl 450):1–101. doi: 10.1111/j.1651-2227.2006.tb02378.x
doi: 10.1111/j.1651-2227.2006.tb02378.x
WHO Multicentre Growth Reference Study Group, de Onis M, Onyango A, Borghi E, Siyam A, Pinol A. WHO child growth standards: growth velocity based on weight, length and head circumference: methods and development. Accessed Oct 8, 2020. https://apps.who.int/iris/handle/10665/44026
Papageorghiou AT, Kennedy SH, Salomon LJ, Ohuma EO, Ismail LC, Barros FC, et al. International standards for early fetal size and pregnancy dating based on ultrasound measurement of crown-rump length in the first trimester of pregnancy. Ultrasound Obstet Gynecol 2014;44:641–8. doi: 10.1002/uog.13448
doi: 10.1002/uog.13448
Altman DG, Ohuma EO. Statistical considerations for the development of prescriptive fetal and newborn growth standards in the INTERGROWTH-21stProject. BJOG Int J Obstet Gynaecol 2013;120(suppl 2):71–6. doi: 10.1111/1471-0528.12031
doi: 10.1111/1471-0528.12031
Ohuma EO, Altman DG. The INTERGROWTH-21st Project. Statistical methodology for constructing gestational age-related charts using cross-sectional and longitudinal data: the INTERGROWTH-21st project as a case study. Stat Med 2019;38:3507–26. doi: 10.1002/sim.8018
doi: 10.1002/sim.8018
Ohuma EO, Altman DG. The INTERGROWTH-21st Project. Design and other methodological considerations for the construction of human fetal and neonatal size and growth charts. Stat Med 2019;38:3527–39. doi: 10.1002/sim.8000
doi: 10.1002/sim.8000
Villar J, Papageorghiou AT, Pang R, Ohuma EO, Ismail LC, Barros FC, et al. The likeness of fetal growth and newborn size across non-isolated populations in the INTERGROWTH-21st project: the fetal growth longitudinal study and newborn cross-sectional study. Lancet Diabetes Endocrinol 2014;2:781–92. doi: 10.1016/S2213-8587(14)70121-4
doi: 10.1016/S2213-8587(14)70121-4
Atkins AFJ, Watt JM, Milan P, Davies P, Crawford JS. A longitudinal study of cardiovascular dynamic changes throughout pregnancy. Eur J Obstet Gynecol Reprod Biol 1981;12:215–24. doi: 10.1016/0028-2243(81)90012-5
doi: 10.1016/0028-2243(81)90012-5
Magee L, von Dadelszen P. Prevention and treatment of postpartum hypertension. The Cochrane Database of Systematic Reviews 2013, Issue 4. Art. No.: CD004351. doi: 10.1002/14651858.CD004351.pub3
Acosta CD, Kurinczuk JJ, Lucas DN, Tuffnell DJ, Sellers S, Knight M. Severe maternal sepsis in the UK, 2011-2012: a national case-control study. PLoS Med 2014;11:2011–2. doi: 10.1371/journal.pmed.1001672
doi: 10.1371/journal.pmed.1001672
UK Sepsis Trust. Inpatient maternal sepsis tool. Accessed October 8, 2020. https://sepsistrust.org/professional-resources/clinical/
Scottish Patient Safety Programme, Maternity and Children Quality Improvement Collaborative. Scottish maternity early warning score (MEWS) chart. Accessed Oct 8, 2020. https://ihub.scot/media/5308/national-mews-chart_web.pdf
Brown MA, Magee LA, Kenny LC, Karumanchi SA, McCarthy FP, Saito S, et al. Hypertensive disorders of pregnancy: ISSHP classification, diagnosis, and management recommendations for international practice. Hypertension 2018;72:24–43. doi: 10.1161/HYPERTENSIONAHA.117.10803
doi: 10.1161/HYPERTENSIONAHA.117.10803
National Institute for Health and Care Excellence (NICE). Hypertension in pregnancy: diagnosis and management (NG133). NICE; 2019.
Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (sepsis 3). JAMA 2016;315:801–10. doi: 10.1001/jama.2016.0287
doi: 10.1001/jama.2016.0287
Office for National Statistics. Births by parents' characteristics in England and Wales: 2016. Accessed Oct 8, 2020. https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/livebirths/bulletins/birthsbyparentscharacteristicsinenglandandwales/2016
Knight M, Kurinczuk JJ, Spark P, Brocklehurst P. Extreme obesity in pregnancy in the United Kingdom. Obstet Gynecol 2010;115:989–97. 10.1097/AOG.0b013e3181da8f09
doi: 10.1097/AOG.0b013e3181da8f09
Office for National Statistics. Ethnicity and national identity in England and Wales: 2011. Accessed Oct 8, 2020. https://www.ons.gov.uk/peoplepopulationandcommunity/culturalidentity/ethnicity/articles/ethnicityandnationalidentityinenglandandwales/2012-12-11

Auteurs

Lauren J Green (LJ)

Nuffield Department of Clinical Neurosciences, the Institute of Biomedical Engineering, Department of Engineering Science, the Nuffield Department of Women's & Reproductive Health, and the Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom; the Department of Anaesthesia, Wellington Hospital, Wellington, New Zealand; and Guy's and St Thomas' NHS Foundation Trust and the Department of Women and Children's Health, King's College, London, and the National Perinatal Epidemiology Unit and the Oxford National Institute for Health Research Biomedical Research Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.

Articles similaires

[Redispensing of expensive oral anticancer medicines: a practical application].

Lisanne N van Merendonk, Kübra Akgöl, Bastiaan Nuijen
1.00
Humans Antineoplastic Agents Administration, Oral Drug Costs Counterfeit Drugs

Smoking Cessation and Incident Cardiovascular Disease.

Jun Hwan Cho, Seung Yong Shin, Hoseob Kim et al.
1.00
Humans Male Smoking Cessation Cardiovascular Diseases Female
Humans United States Aged Cross-Sectional Studies Medicare Part C
1.00
Humans Yoga Low Back Pain Female Male

Classifications MeSH