Differential Diagnosis
- Single most likely diagnosis
- Asymptomatic bacteriuria (ASB) due to Escherichia coli: The patient's urine culture shows >100,000 colony-forming units/mL of Escherichia coli, which is a common cause of ASB in pregnancy. The patient is asymptomatic, which is consistent with this diagnosis.
- Other Likely diagnoses
- Urinary tract infection (UTI): Although the patient is asymptomatic, the presence of Escherichia coli in the urine culture could indicate a UTI. Pregnant women are at increased risk of developing UTIs due to physiological changes.
- Gestational diabetes mellitus (GDM) (although less likely given the normal glucose challenge test result): Although the patient's glucose challenge test result is normal, GDM can still be considered, especially if the patient has risk factors or if the test is repeated.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Preeclampsia: Although the patient's blood pressure is normal, preeclampsia can develop at any time during pregnancy. It is essential to monitor blood pressure and urine protein levels regularly.
- Placenta previa or abruption: Although the patient reports no vaginal bleeding, these conditions can be asymptomatic until a severe event occurs. A detailed ultrasound examination can help rule out these conditions.
- Rare diagnoses
- Interstitial cystitis: This condition is characterized by chronic pelvic pain, pressure, or discomfort related to the bladder, often accompanied by at least one other urinary symptom like persistent urge to void or frequency. Although rare, it could be considered if the patient develops symptoms.
- Kidney stones: Although the patient is asymptomatic, kidney stones can cause severe pain and other complications if left untreated. A detailed medical history and physical examination can help identify risk factors.