THE 4TH SOUND OF KOROTKOFF IN PREGNANCY - A MYTH

Objective: To determine the detection rate and the reproducibility of the first (K1), the fourth (K4) and the fifth (K5) phases of the Korot koff sounds in pregnant women. Study design: In 77 pregnant women rece iving antenatal care in a tertiary referral centre, two observers took 231 simultaneous blood pressure measurements with a shared mercury sp hygmomanometer and a multi-aural stethoscope. Detection rates, percent ages of observer agreement within 5 mmHg and kappa values were calcula ted for K1, K4 and K5. Results: Both observers were able to detect K1, K4 and K5 in 98, 24 and 98% of all 231 measurements, respectively. In 46% of measurements, and in 23% of women, neither observer was able t o detect K4. The observers agreed within 5 mmHg in 98 (kappa = 0.99), 69 (kappa = 0.42), and 96% (kappa = 0.99) of measurements for K1, K4 a nd K5, respectively. Conclusion: K4 cannot be detected and reproduced accurately in a significant proportion of pregnant women, and therefor e should be abandoned as diastolic endpoint in pregnancy. (C) 1998 Els evier Science Ireland Ltd.