Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
correction
- David O Gibbons (11 November 2007)
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Your best cover yet - Nov 2007
- Phillip J. Colquitt (14 November 2007)
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Pre-eclampsia and screening for cardiovascular disease
- Scott M Nelson, Dilys J Freeman, Robert S Lindsay, Naveed Sattar (19 November 2007)
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David O Gibbons, Retired physician Gwel Towans Treloyhan Park Road, St Ives TR26 2AH
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under"nine potentially modifiable risk markers:..............insufficient consumption of alcohol" should read, I presume, "consumption of alcohol" Competing interests: None declared |
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Phillip J. Colquitt, Technicain/RN Independent Comment
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Praise be to the decision makers who covered BMJ's print journal for Nov 10 2007 with a picture of an aneroid gauge. Instead of the iconic yet toxicity encumbered mercury column I note, and in relation to a clinical area [eclampsia] where the accurate measurement of blood pressure is important[1]. However, implementation of aneroid gauges in hospital settings remains generally poorly done. Though regular calibration checks are commendable, I find that faulty gauges are left unreported by nurses between calibration intervals by technicians, contrary to Dondelinger’s observation[2] about “at zero” faults being sometimes the only calibration check done. Education at tertiary level, and policy in clinical settings is needed to require nurses, who collectively take on the "ward management" role, to promptly decommission faulty gauges[hours not days], at such times as the reading at zero falls outside the “zero box”. Nurses at all levels are not sufficiently aware of this need. Recent study shows that midwives [nurses] use too fast a fall rate of blood pressure gauge [3]. Nurses are left floundering, with sometimes three sphygmomanometers at the bedside, when an air leak caused by a faulty cuff to gauge metal Luer connector, renders one gauge temporarily useless. Instead of same day replacement of the connector from ward supply, a ridiculous bureaucratic reporting process involving a chain of more than ten people and numerous forms ensues. The gauge is left for the next unsuspecting nurse to discover. Banning bi-metal Luer connectors on sphygmomanometers would take out one weak link in the chain of error events[4]. 1.L A Magee and P von Dadelszen Pre-eclampsia and increased cardiovascular risk. BMJ 2007; 335: 945-946. 2.Dondelinger RM. Sphygmomanometers. Biomed Instrum Technol. 2005 May -Jun;39(3):210-3. 3.Reinders LW, Mos CN, Thornton C, Ogle R, Makris A, Child A, Hennessy A. Time poor: rushing decreases the accuracy and reliability of blood pressuremeasurement technique in pregnancy. Hypertens Pregnancy. 2006;25(2):81-91. 4.Colquitt PJ. What’s the greatest innovation? Survey response – Spiked May 2007. Accessed on 14 Nov. 2007, Available free full text at: http://www.spiked-online.com/index.php?/innovationsurvey/article/3158/ Competing interests: None declared |
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Scott M Nelson, Clinician Scientist Section of Reproductive & Maternal Medicine, University of Glasgow, G31 2ER, Dilys J Freeman, Robert S Lindsay, Naveed Sattar
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The studies of Bellamy1 and Magnussen2 are clearly important in understanding the pathophysiology of pre-eclampsia and the associations with cardiovascular disease in later life. However, the extrapolation of these studies to widespread adoption of cardiovascular risk factors screening at 3 to 6 months post-partum in women with a history of pre- eclampsia, as suggested in the accompanying editorial3 is a step too far. Although the relative risk is increased two fold, the ‘absolute’ risk for vascular events in the majority of women with pre-eclampsia will remain extremely low due to both young age and female gender. This point cannot be over emphasised since absolute rather than relative risks must influence clinical decision making. Given this low incidence of events and relatively mild excursions of risk factors, widespread risk factor screening for CHD risk in women with recent pre-eclampsia is not warranted. Rather, women with a history of recent pre-eclampsia should be given lifestyle advice to minimise future reproductive risk in the short term, advice which if adopted would also lessen cardiovascular risk in the longer term. Although, some clinicians may argue that prior knowledge of cardiovascular risk factors may be a strong motivational factor for patients and facilitate maintenance of lifestyle modification, there is limited evidence for this, both in terms of practicality and cost-effectiveness. Consequently, we strongly suggest that formal CHD risk screening utilising conventional methods e.g. Framingham risk score, should be restricted to women in their 20s and 30s who also have significant other risk factors such as those with early onset diabetes, or a strong family history of premature vascular disease. For women of an older age, 40 years plus, where opportunistic cardiovascular screening is recommended, it is not yet clear whether a history of pre-eclampsia confers additional cardiovascular risk above that of classical risk factors. Consequently further studies investigating whether a history of pre-eclampsia is an independent risk factor are required before assigning additional risk. References 1. Bellamy L, Casas J-P, Hingorani AD, Williams DJ. Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysis. BMJ 2007;335(7627):974-. 2. Magnussen EB, Vatten LJ, Lund-Nilsen TI, Salvesen KA, Smith GD, Romundstad PR. Prepregnancy cardiovascular risk factors as predictors of pre-eclampsia: population based cohort study. BMJ 2007;335(7627):978-. 3. Magee LA, Dadelszen Pv. Pre-eclampsia and increased cardiovascular risk. BMJ 2007;335(7627):945-946. Competing interests: None declared |
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