Skip to main content
  1. Right Decisions
  2. Maternity & Gynaecology Guidelines
  3. Maternity
  4. Back
  5. Antenatal, general
  6. Home Blood Pressure and Urinalysis Monitoring, Obstetrics (931)
Important: please update your RDS app to version 4.7.3

Welcome to the March 2025 update from the RDS team

1.     RDS issues - resolutions

1.1 Stability issues - Tactuum implemented a fix on 24th March which we believe has finally addressed the stability issues experienced over recent weeks.  The issue seems to have been related to the new “Tool export” function making repeated calls for content when new toolkit nodes were opened in Umbraco. No outages have been reported since then, and no performance issues in the logs, so fingers crossed this is now resolved.

1.2 Toolkit URL redirects failing– these were restored manually for the antimicrobial calculators on the 13th March when the issue occurred, and by 15th March for the remainder. The root cause was traced to adding a new hostname for an app migrated from another health board and made live that day. This led to the content management system automatically creating internal duplicate redirects, reaching the maximum number of permitted redirects and most redirects therefore ceasing to function.

This issue should not happen again because:

  • All old apps are now fully migrated to RDS. The large number of migrations has contributed to the high number of automated redirects.
  • If there is any need to change hostnames in future, Tactuum will immediately check for duplicates.

1.3 Gentamicin calculators – Incidents have been reported incidents of people accessing the wrong gentamicin calculator for their health board.  This occurs when clinicians are searching for the gentamicin calculator via an online search engine - e.g. Google - rather than via the health board directed policy route. When accessed via an external search engine, the calculator results are not listed by health board, and the start page for the calculator does not make it clearly visible which health board calculator has been selected.

The Scottish Antimicrobial Prescribing Group has asked health boards to provide targeted communication and education to ensure that clinicians know how to access their health board antimicrobial calculators via the RDS, local Intranet or other local policy route. In terms of RDS amendments, it is not currently possible to change the internet search output, so the following changes are now in progress:

  • The health board name will now be displayed within the calculator and it will be made clear which boards are using the ‘Hartford’ (7mg/kg) higher dose calculator
  • Warning text will be added to the calculator to advise that more than one calculator is in use in NHS Scotland and that clinicians should ensure they access the correct one for their health board. A link to the Right Decision Service list of health board antimicrobial prescribing toolkits will be included with the warning text. Users can then access the correct calculator for their Board via the appropriate toolkit.

We would encourage all editors and users to use the Help and Support standard operating procedure and the Editors’ Teams channel to highlight issues, even if you think they may be temporary or already noted. This helps the RDS team to get a full picture of concerns and issues across the service.

 

2.     New RDS presentation – RDS supporting the patient journey

A new presentation illustrating how RDS supports all partners in the patient journey – multiple disciplines across secondary, primary, community and social care settings – as well as patients and carers through self-management and shared decision-making tools – is now available. You will find it in the Promotion and presentation resources for editors section of the Learning and support toolkit.

3.     User guides

A new user guide is now available in the Guidance and tips section of Resources for providers within the Learning and Support area, explaining how to embed content from Google Calendar, Google Maps, Daily Motion, Twitter feeds, Microsoft Stream and Jotforms into RDS pages. A webinar for editors on using this new functionality is scheduled for 1 May 3-4 pm (booking information below.)

A new checklist to support editors in making all the checks required before making a new toolkit live is now available at the foot of the “Request a new toolkit” standard operating procedure. Completing this checklist is not a mandatory part of the governance process, but we would encourage you to use it to make sure all the critical issues are covered at point of launch – including organisational tags, use of Alias URLs and editorial information.

4.Training sessions for RDS editors

Introductory webinars for RDS editors will take place on:

  • Tuesday 29th April 4-5 pm
  • Thursday 1st May 4-5 pm

Special webinar for RDS editors – 1 May 3-4 pm

This webinar will cover:

  1. a) Use of the new left hand navigation option for RDS toolkits.
  2. b) Integration into RDS pages of content from external sources, including Google Calendar, Google Maps and simple Jotforms calculators.

Running usage statistics reports using Google analytics

  • Wednesday 23rd April 2pm-3pm
  • Thursday 22nd May 2pm-3pm

To book a place on any of these webinars, please contact Olivia.graham@nhs.scot providing your name, role, organisation, title and date of the webinar you wish to attend.

5.New RDS toolkits

The following toolkits were launched during March 2025:

SIGN guideline - Prevention and remission of type 2 diabetes

Valproate – easy read version for people with learning disabilities (Scottish Government Medicines Division)

Obstetrics and gynaecology induction toolkit (NHS Lothian) – password-protected, in pilot stage.

Oral care for care home and care at home services (Public Health Scotland)

Postural care in care homes (NHS Lothian)

Quit Your Way Pregnancy Service (NHS GGC)

 

6.New RDS developments

Release of the redesign of RDS search and browse, archiving and version control functionality, and editing capability for shared content, is now provisionally scheduled for early June.

The Scottish Government Realistic Medicine Policy team is leading development of a national approach to implementation of Patient-Reported Outcome Measures (PROMs) as a key objective within the Value Based Health and Care Action Plan. The Right Decision Service has been commissioned to deliver an initial version of a platform for issuing PROMs questionnaires to patients, making the PROMs reports available from patient record systems, and providing an analytics dashboard to compare outcomes across services.  This work is now underway and we will keep you updated on progress.

The RDS team has supported Scottish Government Effective Prescribing and Therapeutics Division, in partnership with Northern Ireland and Republic of Ireland, in a successful bid for EU funding to test develop, implement and assess new integrated care pathways for polypharmacy, including pharmacogenomics. As part of this project, the RDS will be working with NHS Tayside to test extending the current polypharmacy RDS decision support in the Vision primary care electronic health record system to include pharmacogenomics decision support.

7. Implementation projects

We have just completed a series of three workshops consulting on proposed improvements to the Being a partner in my care: Realistic Medicine together app, following piloting on 10 sites in late 2024. This app has been commissioned by Scottish Government Realistic Medicine to support patients and citizens to become active partners in shared decision-making and encouraging personalised care based on outcomes that matter to the person. We are keen to gather more feedback on this app. Please forward any feedback to ann.wales3@nhs.scot

 

 

Home Blood Pressure and Urinalysis Monitoring, Obstetrics (931)

Warning Warning: This guideline is 320 day(s) past its review date.
Please report any inaccuracies or issues with this guideline using our online form

Raised blood pressure (BP) affects approximately 10% of pregnancies worldwide; almost half of these women develop pre-eclampsia. Globally, around 15% of maternal mortality is due to preeclampsia so early detection and prevention are paramount. 

The COVID-19 pandemic has required the NHS to urgently consider self-monitoring of BP at home by pregnant women in order to safely reduce the number of face-to-face consultations for pregnant and postnatal women. 

Self-monitoring of BP at home by pregnant women can either be used to replace measurement of blood pressure by a healthcare professional on the day of a scheduled clinic (i.e. intermittently) or can be done routinely and more frequently by pregnant women (e.g. daily or weekly) in addition to usual care.

Self-monitoring of blood pressure by pregnant women is going to be rolled out in phases to high-risk women.   Home monitoring will be initially targeted to women at high-risk of hypertensive complications or who are ‘shielded’ because of serious underlying medical conditions (Group 1), followed by women identified at increased risk of hypertensive complications (Group 2). 

Home blood pressure monitoring should NOT replace any appointment where a woman is receiving clinical review for her underlying medical condition (e.g. for respiratory review of cystic fibrosis or cardiac review of underlying cardiac condition) or where fetal assessment is required as part of the clinical review. 

All requests for home BP monitoring in GGC must be discussed and approved by a consultant.  The named consultant must have recorded in BadgerNet that they agree to home monitoring and outline the follow-up plan.

Group 1
Women identified as 'high risk' of hypertensive complication including: 

  • Chronic Hypertension
  • Current Gestational Hypertension (Pregnancy Induced Hypertension, PIH)
  • Current Pre-eclampsia

Women who have been advised to shield because of serious underlying medical conditions:

  • Cystic Fibrosis
  • Solid organ transplant
  • Cardiac conditions

Group 2
'Increased risk' of developing Pre-eclampsia

  • Hypertensive disease during a previous pregnancy
  • Chronic Kidney Disease
  • Autoimmune disease (eg SLE / Antiphospholipid syndrome)

All women being considered for home blood pressure monitoring must fulfil the following clinical inclusion and exclusion criteria: 

Inclusion criteria

  • Systolic BP range ≤140 mmHg
  • Diastolic BP range ≤100 mmHg
  • Proteinuria ≤ 1+ on urine dipstick
  • Normal full blood count, liver and renal function blood tests as baseline and when new proteinuria present

Exclusion criteria

  • Maternal age <16 years at booking.
  • Systolic BP >140 mmHg
  • Diastolic BP >100 mmHg
  • Proteinuria ≥ 2+ on urine dipstick
  • Symptoms of headaches, visual symptoms, epigastric pain
  • Significant mental health concerns
  • Women who are not capable of giving informed consent
  • Women who are not able to operate home blood pressure equipment
  • Fetal growth restriction
  • Women not wishing to take this responsibility

Eligibility should be considered on an individual basis for each woman, and in context of other pregnancy care guidance.   Consideration should be given to ensuring that the woman has sufficient digital literacy, data/internet and devices to participate in remote consultations.

  1. Arrange for a woman to attend face to face appointment in Daycare Unit. Ask her to bring her mobile phone with her to the appointment. If a woman already has a blood pressure monitor at home, all NHS-issued monitors are validated. If she owns her own device, ask her to bring it to the appointment so the obstetrician can check it is suitable for use in pregnancy. 

  2. Provide antenatal or postnatal check as usual. Assess eligibility to participate in self-monitoring of blood pressure and urinalysis. Ensure contact details are up to date on BadgerNet (home, mobile phone, number, and email).

  3. Provide an NHS device and an appropriately sized cuff (check upper arm measurement). In some cases, proxy measures may be taken from the forearm. Complete a blood pressure monitor loan form with the woman, ensuring the asset is appropriately labelled and tracked and informed consent is given.

  4. If a woman has brought her own blood pressure monitor to the appointment, validate it as suitable for pregnancy and puerperium. The following are validated monitors:

  1. Give written instructions on how to take a blood pressure reading (patient information leaflet) and signpost the link to the short video: British Heart Foundation - How to take your own blood pressure. Use teach-back to show the woman how to take her own blood pressure, write down and interpret her results. Ask the woman to take her blood pressure by herself twice, at least one minute apart, to demonstrate understanding (patient information leaflet).

  2. Give written instructions on how to self-monitor for proteinuria and glycosuria (patient information leaflet). As above, use teach-back to ensure the woman understands how to use the test and where and how to record her results.

Glycosuria detected by routine antenatal testing: be aware that glycosuria of 2+ or above on 1 occasion or of 1+ or above on 2 or more occasions detected by reagent strip testing during routine antenatal care may indicate undiagnosed gestational diabetes. If this is observed, consider further testing to exclude gestational diabetes.  

  1. Give written instructions on expected frequency of blood pressure monitoring and urinalysis, making clear whether this will be done in place of usual care (e.g. on the morning of a scheduled telephone/ virtual clinic appointment) or in addition to usual care (e.g. once a week, three times a week etc).

  2. Make clear home-readings will not be reviewed by a healthcare professional unless it is before a pre-organised clinic appointment or virtual contact. Women should be discouraged from recording readings at unspecified times.  However, ensure she understands who to contact if she is concerned.  
  3. If a woman requires additional investigations / appointments (e.g. growth scan, obstetric clinic follow-up etc), arrange as per local guidelines.

  4. Provide a paper blood pressure recording diary and show her how to use it.

  5. Please inform the woman that it is vital that they follow the written instructions and phone the hospital contact number if they develop raised blood pressure, new proteinuria, increasing proteinuria, or new symptoms.

  6. Book the next appointment with the woman and discuss whether this will be telephone (or other remote working) or face-to-face. A robust plan must be documented in BadgerNet for named consultant review in some format.

  7. Inform the GP that the woman is undertaking home blood pressure monitoring.

  8. Explain the arrangements to the woman for the return of the blood pressure monitor (local arrangements). Once returned, wipe the blood pressure monitor thoroughly with a cleaning wipe, and check that all components are correct.

Editorial Information

Last reviewed: 14/05/2020

Next review date: 23/05/2024

Author(s): Janet Brennand.

Version: 2

Approved By: Obstetrics Clinical Governance Group

Document Id: 931