In a 28‑week‑plus (28 weeks + 5 days) pregnant woman with a singleton fetus in cephalic presentation and appropriate estimated fetal weight, CBC (complete blood count) shows Hgb (hemoglobin) 134 g/L, Hct (hematocrit) 0.40, WBC (white blood cell count) 15.7 ×10⁹/L, platelets adequate; blood type AB+; UA (urinalysis) negative for albumin and glucose, few WBCs/RBCs, scant bacteria; HbsAg (hepatitis B surface antigen) nonreactive, VDRL (Venereal Disease Research Laboratory) nonreactive; FBS (fasting blood sugar) 76 mg/dL, 1‑hour OGTT (oral glucose tolerance test) 109 mg/dL, 2‑hour OGTT 95 mg/dL; and UTZ (ultrasound) shows normal placenta and adequate amniotic fluid. What is the interpretation of these findings and the recommended management?

Interpretation of Laboratory and Ultrasound Findings at 28 Weeks + 5 Days Gestation

These results demonstrate a reassuring pregnancy with normal glucose tolerance, physiologic anemia of pregnancy, possible asymptomatic bacteriuria requiring treatment, and appropriate fetal growth with favorable presentation.

Hematologic Parameters

The hemoglobin of 134 g/L (13.4 g/dL) and hematocrit of 0.40 are within normal range for late second/early third trimester pregnancy. 1

• Physiologic anemia of pregnancy results from disproportionate plasma volume expansion (40-50%) compared to red cell mass increase (20-30%), causing hemodilution 1
• These values are above the anemia threshold and require no intervention at this time 1
• The elevated WBC count of 15.7 × 10⁹/L is within the normal physiologic leukocytosis of pregnancy and does not indicate infection in isolation 1
• Adequate platelet count is reassuring and requires no further evaluation 1

Urinalysis Findings

The presence of 6-10 WBCs/hpf with few bacteria suggests possible asymptomatic bacteriuria that warrants urine culture and treatment if positive.

• The negative albumin and glucose are reassuring, excluding proteinuria and glycosuria 2
• The 1-2 RBCs/hpf and few epithelial cells are within normal limits 3
• Asymptomatic bacteriuria in pregnancy requires treatment due to increased risk of pyelonephritis and preterm labor, even without symptoms 3
• A urine culture should be obtained to confirm bacteriuria and guide antibiotic selection 3

Infectious Disease Screening

The nonreactive HBsAg and VDRL indicate no evidence of hepatitis B or syphilis infection, which is reassuring for both maternal and fetal health. 2

• No further action is required for these negative screening tests 2
• Blood type AB+ is documented for potential transfusion needs and Rh compatibility (Rh-positive status means RhoGAM is not required for routine prophylaxis) 3

Glucose Metabolism Assessment

The glucose tolerance test results are completely normal, definitively excluding gestational diabetes mellitus.

• Fasting blood sugar of 76.14 mg/dL is well below the diagnostic threshold of 92 mg/dL (5.1 mmol/L) 2
• 1-hour OGTT of 109.08 mg/dL is well below the diagnostic threshold of 180 mg/dL (10.0 mmol/L) 2
• 2-hour OGTT of 95.58 mg/dL is well below the diagnostic threshold of 153 mg/dL (8.5 mmol/L) 2
• Using the one-step 75-g OGTT strategy, gestational diabetes is diagnosed only when any single value meets or exceeds the thresholds; all three values here are normal 2
• No dietary modifications, glucose monitoring, or diabetes-specific interventions are indicated 2

Ultrasound Assessment

The fetal biometry, presentation, amniotic fluid, and placental findings are all normal and reassuring at this gestational age.

Gestational Age and Fetal Weight

• Gestational age of 28 weeks + 5 days by fetal biometry is consistent with dating 4
• Estimated fetal weight at 10.6th percentile is appropriate for gestational age (normal range is 10th-90th percentile) 4
• Fetal growth restriction is not present, as this would require estimated fetal weight below the 10th percentile 4

Fetal Presentation

• Cephalic (head-down) presentation at 28 weeks + 5 days is favorable and has a 99.25% chance of remaining cephalic until delivery 5
• At this gestational age, only 0.75% of fetuses in cephalic presentation convert to breech or other abnormal presentations 5
• No intervention is required for presentation at this time 5

Amniotic Fluid

• Adequate amniotic fluid by single deepest vertical pocket measurement is normal 6
• This finding is consistent with normal glucose tolerance, as polyhydramnios is associated with poorly controlled diabetes 6

Placental Assessment

• Posterior, high-lying Grade II placenta is a normal finding at this gestational age 3
• The posterior location and high position exclude placenta previa 3
• Grade II placental maturation is appropriate for late second/early third trimester 3

Recommended Management

Continue routine prenatal care with the following specific actions:

• Obtain urine culture to evaluate for asymptomatic bacteriuria and treat with appropriate antibiotics if positive 3
• Continue routine prenatal visits every 2 weeks until 36 weeks, then weekly 2
• No additional glucose testing is required given normal OGTT results 2
• No anemia treatment is indicated given normal hemoglobin 1
• Routine fetal surveillance with no additional ultrasounds required unless clinically indicated 4
• Counsel regarding normal fetal movement monitoring and warning signs (decreased movement, vaginal bleeding, fluid leakage, contractions) 3

Critical Pitfall to Avoid

Do not dismiss the urinalysis findings of WBCs and bacteria without obtaining a urine culture, as untreated asymptomatic bacteriuria significantly increases the risk of pyelonephritis and preterm labor in pregnancy. 3