Case Challenge: Woman Presents to Emergency Department With Headache and Hypertension

Lisa M. Hollier, MD, MPH; Carolyn K. Holland, MD, Med; Brittany R. Behm, MPH; Eliza C. Miller, MD, MS; Jenna M. B. White, MD; Christopher M. Zahn, MD; Nicole D. Ford, PhD, MPH; Deborah Burch, DNP, RN; Bethany Scalise, BSN; Amy St. Pierre, MBA


September 23, 2022

Editorial Collaboration

Medscape &

Important Question for Women of Reproductive Age

This 25-year-old patient is of reproductive age and should be asked if she is pregnant or was pregnant in the past year.

It is critical for healthcare professionals to ask all women of reproductive age if they are pregnant or were pregnant in the past year. While the physiologic changes of pregnancy persist for several months, the risks for pregnancy-related complications continue for 1 year after pregnancy ends, regardless of whether the pregnancy resulted in a live birth. Both pregnancy-related physiologic changes and complications are important to consider for making an accurate diagnosis and for identifying appropriate therapy. Pregnancy or postpartum status may not be something your patient thinks is important to disclose.

The patient indicated that she had a vaginal delivery of a term infant 10 days prior to this ED visit and is breastfeeding. A review of hospital records shows that she had no prenatal complications and no hypertension during pregnancy or her delivery hospitalization. She received epidural analgesia. She has not used illicit substances, nor has she taken ibuprofen or decongestants. She took several of the butalbital-acetaminophen-caffeine tablets with only minimal improvement in pain. She had no history of trauma.

Complete blood count showed a white blood cell count of 10.7 x103/µL with normal differential, hemoglobin level of 9.7 g/dL, hematocrit of 30.3%, and platelet count of 426 x103/µL. Her basic metabolic panel was normal. She had a protein/creatinine ratio of 0.4 with serum creatinine of 0.9 mg/dL.

Her vital signs were repeated 1 hour into the ED visit. Her blood pressure was 162/110 mm Hg, heart rate 76 beats/min, respiratory rate 16 breaths/min, and oxygen saturation was 100% on room air. Fifteen minutes later, her blood pressure was 166/112 mm Hg.