Conclusions

• Obstetricians and midwives should be aware of the difficulties in measuring blood pressure and proteinuria; and should try at all times to obtain the most accurate measures.
• Korotkov phase V, the disappearance of sounds, should be used for the measurement of diastolic blood pressure.
• All blood pressure measuring equipment should be adequately maintained and its accuracy regularly checked.
• Where possible a 24 hour urine save should be used to quantify the amount of protein being lost through the kidneys. However, there are several limitations even with this "gold standard" technique and it is important that each local hospital is aware of the quality controls in its host laboratory.
• Likewise dipstix need to be used with caution and equivocal results should be checked.
• The 2 major classification systems for the hypertensive disorders in pregnancy rely on hypertension and proteinuria to make the diagnosis of pre-eclampsia. However, clinicians should be aware that the condition can present in a multitude of ways as it affects many organ systems within the body. This fact has been recognised by the Australasian Society for the Study of Hypertension in Pregnancy and all clinicians should be wary of the unusual presentation of the disease pre-eclampsia.
• The drugs which are first line agents to treat hypertension in pregnancy are Methyldopa and Labetalol with Nifedipine being the second line agent. For acute crises Hydralazine has the longest track record but there is evidence now that Nifedipine is equally as good if not better.