# Blood Pressure, Urinalysis, and Edema Assessment in Perinatal Care: From Historical Foundations to Evidence-Based Practice

## TL;DR

This paper reviews the historical and current role of blood pressure, urinalysis, and edema assessments in prenatal care, emphasizing the need for evidence-based improvements.

## Contribution

The paper critically examines the triad's unresolved issues and proposes evidence-based strategies to enhance its clinical utility.

## Key findings

- The triad has historically reduced maternal mortality but lacks conclusive evidence linking it to improved outcomes.
- Home blood pressure monitoring and standardized postpartum proteinuria criteria are recommended for better care.
- Noninvasive and low-cost assessments could optimize outcomes if supported by robust evidence.

## Abstract

The triad of blood pressure measurement, urinalysis, and edema assessment has constituted the cornerstone of prenatal care for over eight decades and has been consistently recorded at each examination in Japan’s Maternal and Child Health Handbook. Historically, these examinations were prioritized to facilitate the early diagnosis and treatment of pregnancy toxemia―now termed hypertensive disorders of pregnancy―which once represented a leading cause of maternal mortality. The triad has undeniably played a pivotal role in the early diagnosis, prediction, and treatment of hypertensive disorders of pregnancy, while potentially contributing to the detection of other obstetric complications. However, conclusive evidence linking these conventionally performed assessments to actual pregnancy and delivery outcomes remains limited, and critical unresolved issues persist within each examination category. Blood pressure assessment requires the establishment of optimal blood pressure thresholds to achieve favorable pregnancy and perinatal outcomes; to achieve this, home blood pressure monitoring should be adopted. Evidence-based target blood pressure ranges for treatment initiation in hypertensive disorders of pregnancy and therapeutic targets are urgently needed. For urinary protein assessment, the establishment of standardized criteria for postpartum proteinuria follow-up is essential. In terms of edema, critical evidence is lacking regarding the evaluation and treatment of pathological edema that adversely affects pregnancy outcomes. This review traces the historical evolution of these examinations while critically examining their contemporary role in perinatal care. A notable characteristic of this triad is its noninvasive nature and minimal cost burden. The establishment of robust evidence supporting their clinical utility could optimize maternal and fetal outcomes while maintaining cost-effective healthcare delivery.