Approach to hypertensive disorders in pregnancy Quiz: Ace Your Exams

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A 36-year-old woman, gravida 3, para 2, at 35 weeks of gestation, presents to Labor and Delivery triage with a severe headache unrelieved by acetaminophen, which has been getting progressively worse over the last eight hours. She denies vision changes, abdominal pain, contractions, bleeding, loss of fluid, or decreased fetal movement. Past medical history is notable for two prior uncomplicated vaginal deliveries, and her only medication is a prenatal vitamin. Her antenatal records thus far are shown below. Temperature is 36.5°C (97.7°F), pulse is 82/min, respirations are 16/min, and blood pressure is 144/84 mmHg. The exam is notable for 2+ pitting edema to the knees bilaterally, and the fetal heart rate pattern is reassuring on cardiotocographic monitoring. Urinalysis shows 2+ proteinuria and additional labs are pending. Which of the following is the most likely diagnosis based on the information currently available? 

 Gestational age     Maternal BP      Fetal HR      Fundal height      Proteinuria     Fetal Movement    
 8w 5d     126/82     150s     -     0     -    
 13w 3d     134/90     140s     -     0     -    
 18w 2d     128/92     140s     -     0     +    
 22w 4d     136/86     140s     22 cm     0     +    
 26w 3d     132/84     140s     25 cm     0     +    
 30w 1d     130/82     130s     29 cm     0     +    
 32w 5d      136/80     130s     32 cm     1+     +    

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