THIS Institute, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
Primary Care Clinical Sciences, Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
BMJ Open. 2020 Dec 1;10(12):e037874. doi: 10.1136/bmjopen-2020-037874.
One in 20 women are affected by pre-eclampsia, a major cause of maternal and perinatal morbidity, death and premature birth worldwide. Diagnosis is made from monitoring blood pressure (BP) and urine and symptoms at antenatal visits after 20 weeks of pregnancy. There are no randomised data from contemporary trials to guide the efficacy of self-monitoring of BP (SMBP) in pregnancy. We explored the perspectives of maternity staff to understand the context and health system challenges to introducing and implementing SMBP in maternity care, ahead of undertaking a trial.
Exploratory study using a qualitative approach.
Eight hospitals, English National Health Service.
Obstetricians, community and hospital midwives, pharmacists, trainee doctors (n=147).
Semi-structured interviews with site research team members and clinicians, interviews and focus group discussions. Rapid content and thematic analysis undertaken.
The main themes to emerge around SMBP include (1) different BP changes in pregnancy, (2) reliability and accuracy of BP monitoring, (3) anticipated impact of SMBP on women, (4) anticipated impact of SMBP on the antenatal care system, (5) caution, uncertainty and evidence, (6) concerns over action/inaction and patient safety.
The potential impact of SMBP on maternity services is profound although nuanced. While introducing SMBP does not reduce the responsibility clinicians have for women's health, it may enhance the responsibilities and agency of pregnant women, and introduces a new set of relationships into maternity care. This is a new space for reconfiguration of roles, mutual expectations and the relationships between and responsibilities of healthcare providers and women.
NCT03334149.
全世界每 20 名女性中就有 1 名受到子痫前期的影响，子痫前期是全球孕产妇和围产期发病率、死亡率和早产的主要原因。诊断是通过在怀孕 20 周后在产前检查时监测血压（BP）、尿液和症状来进行的。目前还没有来自当代试验的随机数据来指导妊娠期间自我监测血压（SMBP）的疗效。在进行试验之前，我们探讨了产妇工作人员的观点，以了解在产妇护理中引入和实施 SMBP 的背景和卫生系统挑战。
使用定性方法进行的探索性研究。
英国国民保健制度的八家医院。
产科医生、社区和医院助产士、药剂师、实习医生（n=147）。
对现场研究团队成员和临床医生进行半结构化访谈，对医护人员进行访谈和焦点小组讨论。进行快速内容和主题分析。
围绕 SMBP 出现的主要主题包括（1）妊娠期间不同的血压变化，（2）BP 监测的可靠性和准确性，（3）SMBP 对女性的预期影响，（4）SMBP 对产前保健系统的预期影响，（5）谨慎、不确定性和证据，（6）对行动/不作为和患者安全的担忧。
虽然引入 SMBP 并没有减轻临床医生对女性健康的责任，但它可能会增强孕妇的责任和自主权，并将一套新的关系引入到产妇护理中。这是一个重新配置角色、相互期望以及医疗保健提供者和女性之间关系和责任的新领域。
NCT03334149。
