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A 28-year-old primigravida at 27 weeks’ gestation is referred by her primary care provider to your tertiary center’s high-risk obstetrics unit with a four-week history of worsening exertional dyspnea, marked fatigue with limited daily activities, and a recent syncopal episode, witnessed by her husband. She describes palpitations immediately prior to this brief event. She is asymptomatic at rest and has not experienced chest pain. Her medical history appears non-contributory, and although she practices healthy social habits, she has long-standing exercise intolerance in the non pregnant state with breathlessness after running a few meters.
A 29-year-old G1P0 at 32 weeks’ gestation is brought in by ambulance to the A&E (E.R.) department in your tertiary trauma center following a road traffic accident. She was the restrained driver of a vehicle driving on an icy road at around 50 mph (80 km/h), when she lost control and had a frontal impact collision with another vehicle. She is healthy and has had an unremarkable pregnancy to date. On arrival, she is alert but appears anxious and uncomfortable. Her cervical spine is immobilized with a cervical collar and blocks, and she is on a spinal board. She complains of pains in her chest and lower abdomen. There is a bruise across her right forehead. Her vital signs show a sinus tachycardia of 115 bpm, blood pressure 87/62 mmHg, pulse oximetry 94% on room air, respiratory rate 28/min, and core temperature of 34.6°C. You are covering the birthing center and have been called urgently to the A&E department to assist in the management of this patient.
During your obstetric call duty in a tertiary hospital center, you receive a telephone call from a colleague at an external center for an incidental isolated platelet count of 69 × 109/L in a 22-year-old primigravida with a singleton pregnancy at 24+3 weeks’ gestation by early dating sonography. The full/complete blood count (FBC/CBC) was performed to follow up on iron-deficiency anemia. Fetal activity is normal.