From the Guidelines
A normal finding in this 36-year-old pregnant woman at 9 weeks gestation would be a blood pressure of 120/70 mm Hg, as it falls within the normal range for pregnancy, with a 24-hour average blood pressure below 126/76 mm Hg, as recommended by the ISSHP 1.
Normal Blood Pressure in Pregnancy
The International Society for the Study of Hypertension in Pregnancy (ISSHP) defines normal blood pressure in pregnancy as a 24-hour average blood pressure below 126/76 mm Hg, with awake average blood pressure below 132/79 mm Hg, and sleep average blood pressure below 114/66 mm Hg 1.
Key Points
- The patient's blood pressure of 120/70 mm Hg is within the normal range for pregnancy.
- The ISSHP recommends that blood pressure be monitored regularly during pregnancy to detect any potential issues early on.
- The patient's history of preeclampsia in her previous pregnancy is significant, but it does not affect the interpretation of her current blood pressure reading at this early gestational age.
Laboratory Tests
The patient's prenatal laboratory tests, including a complete blood count, basic metabolic panel, urinalysis, and urine culture, are all important for monitoring her health during pregnancy.
- A normal complete blood count may show mild anemia, with a hemoglobin level around 11.0 g/dL, which is a normal adaptation to pregnancy due to plasma volume expansion.
- The basic metabolic panel may show slightly decreased blood urea nitrogen and creatinine due to increased glomerular filtration rate.
- The urinalysis may show mild glucosuria due to increased glomerular filtration of glucose.
Management
The ISSHP recommends that women with a history of preeclampsia be monitored closely during pregnancy, with regular blood pressure checks and laboratory tests to detect any potential issues early on 1.
- The patient should be assessed for any signs of preeclampsia, such as proteinuria, severe hypertension, or neurological signs and symptoms.
- If any of these signs are present, the patient should receive magnesium sulfate for convulsion prophylaxis and be delivered if necessary.
From the Research
Normal Findings in Prenatal Care
The patient's prenatal laboratory tests include a complete blood count, basic metabolic panel, urinalysis, and urine culture. Considering the patient's healthy status and lack of any underlying medical conditions, the following would be considered normal findings:
- A complete blood count (CBC) with normal parameters, such as red blood cell count, hemoglobin, hematocrit, white blood cell count and differential, and platelet count 2
- A basic metabolic panel with normal electrolyte levels, including potassium and chloride, as well as normal blood urea nitrogen and creatinine levels, indicating normal renal function and acid-base homeostasis 3
- A urinalysis with no evidence of infection, proteinuria, or other abnormalities, and a negative urine culture 4
- The patient's blood pressure and BMI are within normal limits, which is consistent with a low-risk pregnancy 5, 6
Laboratory Tests in Preeclampsia
It is worth noting that the patient has a history of preeclampsia in her previous pregnancy. Studies have shown that certain laboratory tests, such as complete blood count parameters, can be used to predict severe preeclampsia 5, 6. However, these tests are not typically used as screening tools in low-risk pregnancies. Instead, they may be used to monitor patients with a history of preeclampsia or other risk factors.
- A study published in 2021 found that changes in lymphocyte, mean platelet volume (MPV), and neutrophil lymphocyte ratio (NLR) values over time can be used to predict severe preeclampsia 5
- Another study published in 2024 used machine learning models to identify complete blood count parameters that can be used to diagnose preeclampsia with severe features, including neutrophils count, mean corpuscular hemoglobin (MCH), and the aggregate index of systemic inflammation (AISI) 6