When during pregnancy should base line lab tests be performed for woman with chronic hypertension?

Updated: Jun 12, 2018
  • Author: Michael P Carson, MD; Chief Editor: Edward H Springel, MD, FACOG  more...
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Answer

Answer

For a woman with chronic hypertension in her first trimester, obtain the following laboratory studies (to serve as baseline values, to be referred to later in the pregnancy if a concern regarding superimposed preeclampsia arises): CBC count, electrolytes, BUN, creatinine, liver enzymes, and urine dip for protein and a 24-hour urine collection for creatinine clearance and protein excretion.

Spot urine specimens for obtaining protein/creatinine ratio can fulfill the proteinuria diagnostic criteria for pre-eclampsia. A ratio of greater than 0.3 (when each is measured as mg/dL) is an acceptable equivalent to 24 urine protein greater than 300mg/day for diagnosis of pre-eclampsia. [1]

Serum lipids (ie, total cholesterol, high-density lipoprotein [HDL], low-density lipoprotein [LDL], triglycerides) predictably increase during pregnancy, so measurement should be deferred until the postpartum period. In addition, the increase in endogenous corticosteroid levels during normal pregnancy makes it difficult to evaluate for secondary hypertension due to adrenal corticosteroid excess. Hyperaldosteronism and hypercortisolism are difficult to diagnose during pregnancy due to the high levels of progesterone and the normal increase in endogenous cortisol output.


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