A 34-year-old woman, gravida 3 para 2, presents to the labor and delivery unit at 39 weeks of gestation in active labor. Her pregnancy has been complicated by mild polyhydramnios diagnosed at 32 weeks, but she has otherwise been healthy. She undergoes an uneventful induction of labor. However, during the second stage of labor, she suddenly becomes cyanotic and complains of severe shortness of breath. Within minutes, she loses consciousness and exhibits signs of cardiovascular collapse, including hypotension and tachycardia. The labor and delivery team initiates immediate resuscitative measures, including oxygen supplementation and intravenous fluid boluses. Despite these interventions, her blood pressure continues to drop, and she requires intubation for respiratory support. The fetal heart monitor shows bradycardia. Amniotic fluid embolism is suspected and an emergency cesarean section is performed within 15 minutes. The infant is delivered with an initial Apgar score of 2 but responds well to resuscitation and is transferred to the neonatal intensive care unit for further monitoring. Meanwhile, the mother develops significant vaginal bleeding during surgery, requiring rapid transfusion of blood products. Laboratory results reveal evidence of disseminated intravascular coagulation (DIC). Which laboratory finding is most consistent with disseminated intravascular coagulation (DIC) in amniotic fluid embolism?

A 29-year-old woman, who is 8 weeks pregnant, presents to the obstetrics clinic for her first prenatal visit. She has a history of hypothyroidism diagnosed three years ago and has been on levothyroxine 100 mcg daily. She confirms adherence to her medication. Laboratory tests reveal a TSH level of 4.8 mIU/L (reference range for pregnancy: 0.1–2.5 mIU/L in the first trimester) with normal free T4 levels. Which of the following is the next step in the management of her hypothyroidism during pregnancy?

A 28-year-old pregnant woman, at 20 weeks of gestation, presents to the emergency department with progressive fatigue, drooping eyelids, and intermittent double vision that worsens by the evening and improves with rest. She works as a teacher and reports difficulty chewing food, speaking clearly, and occasional difficulty swallowing. Her pregnancy has been uneventful so far, but she is concerned about how her symptoms might affect her ability to carry her pregnancy to term. On examination: Bilateral ptosis is noted, worsening with sustained effort. Limb weakness is more pronounced proximally than distally. Reflexes are normal, and sensory examination is intact. Ice pack test is positive, and symptoms transiently improve with edrophonium administration. She has been diagnosed with myasthenia gravis (MG) and is seeking guidance on managing her condition during pregnancy. All of the following is true concerning this patient’s disorder during pregnancy EXCEPT

A 28-year-old woman presents to the emergency room with complaints of worsening fatigue and intermittent double vision. These symptoms have been progressively worsening over the last one month. She works as a teacher and the symptoms increase the longer she works on the black board, worse by the evening but relieved with rest. She has also noted drooping of her eyelids, which seems to worsen with prolonged working at the school. A detailed review of systems reveals some difficulty eating, change in voice quality, and weakness in chewing food. Physical examination discloses bilateral ptosis of both eyes that worsens when the patient is asked to actively keep her eyelids elevated. She has limb and trunk weakness in a proximal greater than distal distribution. Her symptoms markedly improved after edrophonium administration. Ice pack test turned out to be positive. Which of the following is the most significant emergency department complication of this disorder?

A 28-year-old woman presents to the emergency room with complaints of shortness of breath and intermittent double vision. While her shortness of breath started two days ago, her double vision has been progressively worsening over the last one month. She works as a teacher and the symptoms increase the longer she works on the black board, worse by the evening but relieved with rest. She has also noted drooping of her eyelids, which seems to worsen with prolonged working at the school. A detailed review of systems reveals some difficulty eating, change in voice quality, and weakness in chewing food. Physical examination discloses bilateral ptosis of both eyes that worsens when the patient is asked to actively keep her eyelids elevated. Her lung examination revealed bilateral wheezing and tachypnea. She has limb and trunk weakness in a proximal greater than distal distribution. Her symptoms markedly improved after edrophonium administration. Ice pack test turned out to be positive. Of the following, which is the most effective agent to treat this disorder?

A 28-year-old woman presents to the emergency room with complaints of shortness of breath and intermittent double vision. While her shortness of breath started two days ago, her double vision has been progressively worsening over the last one month. She works as a teacher and the symptoms increase the longer she works on the black board, worse by the evening but relieved with rest. She has also noted drooping of her eyelids, which seems to worsen with prolonged working at the school. A detailed review of systems reveals some difficulty eating, change in voice quality, and weakness in chewing food. Physical examination discloses bilateral ptosis of both eyes that worsens when the patient is asked to actively keep her eyelids elevated. Her lung examination revealed bilateral wheezing and tachypnea. She has limb and trunk weakness in a proximal greater than distal distribution. Her symptoms markedly improved after edrophonium administration. Ice pack test turned out to be positive. The first screening antibody in this disorder should be which of the following?

A 28-year-old woman presents to the emergency room with complaints of shortness of breath and intermittent double vision. While her shortness of breath started two days ago, her double vision has been progressively worsening over the last one month. She works as a teacher and the symptoms increase the longer she works on the black board, worse by the evening but relieved with rest. She has also noted drooping of her eyelids, which seems to worsen with prolonged working at the school. A detailed review of systems reveals some difficulty eating, difficulty chewing food and change in voice quality. Physical examination discloses bilateral ptosis of both eyes that worsens when the patient is asked to actively keep her eyelids elevated. Her lung examination revealed bilateral wheezing and tachypnea. She has limb and trunk weakness in a proximal greater than distal distribution. Her symptoms markedly improved after edrophonium administration. Ice pack test turned out to be positive. Which of the following is the most common presenting sign in this disease?

A 32-year-old woman visits her obstetrician for her first prenatal appointment at 10 weeks of gestation. She reports that she has continued taking valproic acid for her epilepsy but is concerned after reading about its potential risks during pregnancy. She has not taken any folic acid supplements and reports no significant health issues so far. The obstetrician explains that valproic acid is a known teratogen, particularly during the critical window of fetal heart development. During which gestational weeks is the fetal heart most susceptible to teratogens?