The Association of Women’s Health, Obstetric and
Neonatal Nurses in the United States and Canada –
AWHONN released a clinical protocol focused on the
diagnosis of hypertensive disorders. According to this protocol,
BP should always be assessed in the sitting position
with the arm at heart level. The pressure measured in PLS,
as advocated in previous protocols can lead to a significant
increase of 10-14 mmHg in pressure levels, due to higher
pressure in the left ventricle exerted by maternal position(29).
In addition, it points out that the value of diastolic blood
pressure should be measured in the fifth phase of Korotkoff
(disappearance of sound) and not in the fourth phase (muffling
of the sound), as was reported in previous protocols.
Finally, the protocol indicates ambulatory BP monitoring
(ABPM) in 24 hours as the most effective technique and
able to reduce measurement errors. This technique allows
the evaluation of women in their routine and is a more sensitive
predictor than clinical assessments, even in two measurements
at different times. So it is up to the professionals
to consider the cost-effective use for the diagnosis(30