A 32-year-old primigravida at 39 weeks of gestational age has a blood pressure reading of 150/100 mm Hg obtained during a routine visit. Her baseline blood pressure during the pregnancy was 120/70 mmHg. The patient denies any headache, visual changes, nausea, vomiting, or abdominal pain. Her repeat BP is 160/90 mmHg, and urinalysis is negative for protein. Which of the following is the most likely diagnosis?
A 32-year-old primigravida at 39 weeks of gestational age has a blood pressure reading of 150/100 mm Hg obtained during a routine visit. Her baseline blood pressure during the pregnancy was 120/70 mmHg. The patient denies any headache, visual changes, nausea, vomiting, or abdominal pain. Her repeat BP is 160/90 mmHg, and urinalysis is negative for protein. Which of the following is the most likely diagnosis?
💡 Explanation
## **Core Concept**
The patient's presentation of significantly elevated blood pressure readings (150/100 mmHg and 160/90 mmHg) at 39 weeks of gestation, with a baseline blood pressure of 120/70 mmHg, suggests a diagnosis related to hypertension in pregnancy. The absence of proteinuria and symptoms such as headache, visual changes, or abdominal pain helps to narrow down the differential diagnosis.
## **Why the Correct Answer is Right**
Gestational hypertension, also known as pregnancy-induced hypertension, is characterized by new-onset hypertension presenting after 20 weeks of gestation without significant proteinuria. The patient's blood pressure readings of 150/100 mmHg and 160/90 mmHg at 39 weeks of gestation, with a normal baseline blood pressure, meet these criteria. The lack of proteinuria and symptoms rules out preeclampsia, which is defined by the presence of proteinuria and often accompanied by symptoms.
## **Why Each Wrong Option is Incorrect**
- **Option A:** Preeclampsia typically presents with both hypertension and significant proteinuria, which is not present in this case.
- **Option B:** Chronic hypertension would imply that the patient had elevated blood pressure before pregnancy or before 20 weeks of gestation, which does not align with her baseline blood pressure of 120/70 mmHg during pregnancy.
- **Option D:** Preeclampsia with severe features would include symptoms such as headache, visual disturbances, or severe abdominal pain, which the patient denies.
## **Clinical Pearl / High-Yield Fact**
A key point to remember is that gestational hypertension can progress to preeclampsia, so close monitoring of blood pressure and for signs of preeclampsia is crucial. The absence of proteinuria and symptoms does not exclude the possibility of progression.