Differential Diagnosis
- Single most likely diagnosis
- B. gestational hypertension: This diagnosis is the most likely because the patient has hypertension (blood pressure of 146/92 mmHg and 142/89 mmHg) without a history of chronic hypertension, and proteinuria is not significantly elevated (78 mg/day, which is near the upper limit of normal). Gestational hypertension typically develops after 20 weeks of gestation and is characterized by hypertension without significant proteinuria or other signs of preeclampsia.
- Other Likely diagnoses
- A. chronic hypertension: Although the patient denies any medical problems, it is possible that she had undiagnosed chronic hypertension before pregnancy. However, this is less likely given the absence of any prior medical history.
- E. white coat hypertension: The patient's blood pressure readings are elevated, but it is possible that she has white coat hypertension, which is a condition where blood pressure is elevated in a clinical setting but normal in other settings.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- C. preeclampsia without severe features: Although the patient's proteinuria is not significantly elevated, preeclampsia can still be a consideration, especially if other symptoms or signs develop. Preeclampsia is a serious condition that can lead to severe complications if not recognized and managed promptly.
- D. preeclampsia with severe features: This diagnosis is less likely given the patient's current presentation, but it is essential to consider it as a possibility, especially if her condition worsens or if she develops other symptoms such as severe headache, vision changes, or abdominal pain.
- Rare diagnoses
- Other rare causes of hypertension in pregnancy, such as renal disease or endocrine disorders, are less likely given the patient's presentation and history, but may need to be considered if her condition does not respond to standard management or if other symptoms develop.