Differential Diagnosis
The patient's presentation suggests a potential diagnosis related to her pregnancy and medical history. The following differential diagnosis is organized into categories:
- Single most likely diagnosis:
- Gestational Diabetes Mellitus (GDM): The patient's result of a 3-hour glucose tolerance test is 160 mg/dL, which is above the normal range, indicating impaired glucose tolerance. Her obesity (BMI 33.1 kg) and history of hypertension are also risk factors for GDM.
- Other Likely diagnoses:
- Pregnancy-induced Hypertension: Although the patient's blood pressure is currently within a relatively normal range (133/80), her history of hypertension and obesity put her at risk for developing pregnancy-induced hypertension.
- Multiparity-related complications: As a gravida three, para two, the patient is at increased risk for complications such as placental abruption, postpartum hemorrhage, and fetal growth restriction.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Preeclampsia: Although the patient does not currently have symptoms such as headache or chest pain, her history of hypertension and obesity put her at risk for developing preeclampsia, a potentially life-threatening condition.
- Fetal growth restriction: The patient's obesity and history of hypertension increase her risk for fetal growth restriction, which can have serious consequences for the fetus if left undiagnosed.
- Rare diagnoses:
- Thyroid dysfunction: Although not directly related to the patient's current symptoms, her obesity and history of hypertension increase her risk for thyroid dysfunction, which can have significant effects on pregnancy outcomes.
- Sleep apnea: The patient's obesity puts her at risk for sleep apnea, which can increase her risk for pregnancy-related complications such as preeclampsia and gestational diabetes.