Noninvasive blood pressure measurements demonstrated a significant underestimation of blood pressure in a patient with severe preeclampsia: a case report

Introduction and importance

Accurate diagnosis and management of preeclampsia rely on reliable blood pressure (BP) measurements. This report highlights a case where non-invasive BP monitoring underestimated maternal BP in a patient with severe preeclampsia.

Case presentation

At 27 weeks' gestation, a 33-year-old gravida 1, para 0 presented with blurred vision, diagnosed with chronic hypertension and preeclampsia, incomplete HELLP (elevated liver enzymes and lower platelet count syndrome), and abnormal umbilical artery Doppler. Magnesium sulfate and dexamethasone were administered for fetal lung maturity and maternal seizure prophylaxis. Oral labetalol, nitroglycerin, and urapidil were continuously infused to control non-invasive blood pressure (NIBP), and an emergency cesarean section was planned. Upon arrival in the operating room, left radial intra-arterial blood pressure (RIBP) was recorded as 190/112 mmHg, whereas the NIBP of the left arm was 155/105 mmHg. Intraoperative BP management was guided by RIBP. When the patient was transferred from the transport bed to the intensive care unit bed, the NIBP showed 120/70 mmHg, while the RIBP remained elevated at 180/110 mmHg. Subsequently, interventions including spasmolytic therapy, antihypertensive medications, and sedation were initiated, leading to a progressive reduction in the discrepancy between NIBP and RIBP.

Discussion

NIBP may underestimate actual BP in severe preeclampsia, particularly when maternal BP is poorly controlled. In these patients, invasive blood pressure monitoring may be useful for assessing rapid changes in cardiovascular status.

Conclusion

NIBP may significantly under-estimated actual BP in severe preeclampsia patients with poorly controlled maternal BP. Further research is needed to assess its impact on outcomes.