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The use of low molecular weight heparin for thromboprophylaxis in pregnancy

It has been pointed out that elimination of observer bias is a major advantage of automated devices over the standard mercury sphygmomanometer (Bruce et al. 1988 ; Editorial 1991). Recommendations for therapeutic interventions in hypertensive pregnancy are based upon strict criteria of absolute diastolic mercury blood pressure levels. However, as we have demonstrated in this study (Table l), a Dinamap-recorded diastolic pressure of 75 mmHg could indicate K4 and K5 values up to 103 and 98 mmHg (upper 95 % limit of agreement), respectively. Therefore we doubt whether the elimination of observer bias outweighs the introduction of the measurement errors inherent in these three automated devices, irrespective of the phase IV/V discussion (Davey & MacGillivrey 1988; Perry et al. 1990, Johenning et al. 1992). If one decides to use automated devices for daily practice after all, proper calibration in each individual woman, especially when pre-eclamptic, is mandatory. If consensus will finally be reached between obstetricians on K5 as the best estimate for diastolic blood pressure in pregnancy, this would only slightly diminish our concern about the diastolic measurement error of automated devices in view of the smaller systematic measurement error of K5 compared with K4.