Peer Reviewed

What's the Take Home?

Hypertension in a Pregnant Woman

Lawrence I. Kaplan, MD,
Ronald N. Rubin, MD
Volume 45 - Issue 4 - April 2005

  • A 35-year-old woman who is pregnant for the first time has had elevated blood pressure since she first presented for prenatal care at 28 weeks' gestation. Her blood pressure at that time was 148/94 mm Hg (unchanged in the lateral decubitus position). She is now at 32 weeks' gestation.

    HISTORY

    The patient has no personal or family history of hypertension. At her last checkup 2 years earlier, all findings were normal. She takes no medications and does not smoke, drink, or use illicit drugs. She denies headache, vision changes, chest pain, palpitations, abdominal pain, nausea, and vomiting. She has gained 15 lb since she became pregnant and has bilateral foot swelling but no other symptoms.

    PHYSICAL EXAMINATION

    Blood pressure is 146/94 mm Hg bilaterally, and heart rate is 68 beats per minute. Results of an examination of the head, eyes, ears, nose, throat, and neck are normal. Cardiac examination reveals a grade 2/4 systolic ejection murmur without gallops. Lungs are clear and abdomen is gravid. There is 1+ pedal edema bilaterally but no skin lesions. Results of an obstetric examination are appropriate for 32 weeks' gestation.

    LABORATORY RESULTS

    Results of a metabolic panel are normal. A complete blood cell count reveals a hemoglobin level of 10.5 g/dL, hematocrit of 36%, and normal indices. Urinalysis shows 1+ proteinuria but otherwise normal results.


    What is the most likely cause of this patient's blood pressure elevation?

    A.     Chronic hypertension.

    B. Pregnancy-associated hypertension.

    C. Preeclampsia.

    D. Normal pregnancy-related change in blood pressure.
     

     

    Answer and discussion on next page

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