A 32-year-old woman, gravida 2 para 1, at 35 weeks of gestation, presents to the emergency department with complaints of severe epigastric and right upper quadrant (RUQ) pain for the past 8 hours. She also reports nausea, fatigue, and a headache that has not improved with acetaminophen. She denies seizures, visual disturbances, or vaginal bleeding. Her prenatal care had been uneventful until this visit. Examination Findings: Vital Signs: BP 170/110 mmHg, HR 96 bpm, Temp 98.9°F. General Exam: The patient appears uncomfortable and fatigued. Abdominal Exam: RUQ tenderness without rebound or guarding. Neurological Exam: No focal deficits or signs of clonus. Which of the following laboratory findings is most consistent with HELLP syndrome in this patient?

A 30-year-old woman at 34 weeks of gestation presents to the emergency department with severe preeclampsia. Her blood pressure is 168/110 mmHg, and she has significant proteinuria (4+ on dipstick) and mild headaches. She is admitted to the obstetric ward and started on magnesium sulfate for seizure prophylaxis and antihypertensive therapy. The magnesium sulfate infusion is initiated with a loading dose of 4 g intravenously over 30 minutes, followed by a maintenance dose of 2 g/hour. Her reflexes and vital signs are monitored hourly, and she initially responds well to the therapy. After 8 hours of infusion, the patient begins to report nausea and generalized weakness. The nurse notes that her respiratory rate has decreased to 10 breaths per minute, and her deep tendon reflexes are absent on examination. The patient also complains of flushing and mild dizziness. Concerned about possible magnesium toxicity, the medical team orders immediate serum magnesium levels. At what serum magnesium level do this patient’s current symptoms and signs typically occur?

A 29-year-old woman at 34 weeks of gestation presents to the emergency department with severe preeclampsia. Her blood pressure is 168/110 mmHg, and she has significant proteinuria (4+ on dipstick) and mild headaches. She is admitted to the obstetric ward and started on magnesium sulfate for seizure prophylaxis and antihypertensive therapy. The magnesium sulfate infusion is initiated with a loading dose of 4 g intravenously over 30 minutes, followed by a maintenance dose of 2 g/hour. After 8 hours of infusion, the patient begins to report nausea and generalized weakness. The nurse notes that her respiratory rate has decreased to 10 breaths per minute, and her deep tendon reflexes are absent on examination. The patient also complains of flushing and mild dizziness. What is the appropriate management step in the management of this patient?

A 32-year-old woman at 34 weeks of gestation presents to the emergency department with severe preeclampsia. Her blood pressure is 168/110 mmHg, and she has significant proteinuria (4+ on dipstick) and mild headaches. She is admitted to the obstetric ward and started on magnesium sulfate, with a loading dose of 4 g intravenously over 30 minutes, followed by a maintenance dose of 2 g/hour. After 8 hours of infusion, the patient begins to report nausea and generalized weakness. You suspect magnesium toxicity. What is the earliest clinical sign of magnesium toxicity in patients receiving magnesium sulfate for preeclampsia?

A 32-year-old G2P1 woman at 38 weeks gestation presents to the emergency department with shortness of breath, severe fatigue, and chest tightness. She reports sudden-onset symptoms following a prolonged labor induction for which she received tocolytics. Her past medical history includes preeclampsia during her first pregnancy. She also reports recent vaginal bleeding after a suspected placental abruption. On examination, the patient appears distressed, with a respiratory rate of 30 breaths/min, oxygen saturation of 85% on room air, and crackles heard bilaterally on auscultation. Chest X-ray reveals bilateral infiltrates consistent with pulmonary edema. Laboratory results are significant for proteinuria, thrombocytopenia, and elevated liver enzymes. Which of the following is a cause of acute respiratory distress syndrome (ARDS) unique to pregnancy?

A 29-year-old woman, gravida 3 para 2, at 36 weeks gestation presented to the emergency department with complaints of sudden-onset severe abdominal pain, heavy vaginal bleeding, and decreased fetal movements. Her pregnancy had been uneventful until this episode. She had been exposed to extreme temperatures due to outdoor living during the last ten days. Three days ago, she went to an urgent care center for a severe cough and was prescribed azithromycin for ‘possible bronchitis’. On arrival, she appeared pale, diaphoretic, and visibly distressed. Her temperature is 102 °F , heart rate is 122 beats/min, blood pressure is 90/60 mm Hg, respirations are 34 breaths/min, and oxygen saturation is 89% on room air. On examination, the abdomen was firm and tender to palpation, with a rigid uterus. A bedside ultrasound revealed a retroplacental clot and partial detachment of the placenta. Fetal heart monitoring showed late decelerations and minimal variability. Laboratory results Platelet count: 53,000/μL (normal range: 150,000–450,000/μL) Prothrombin time (PT): 18 seconds (normal range: 10–13 seconds) Activated partial thromboplastin time (aPTT): 40 seconds (normal range: 25–35 seconds) Fibrinogen: 100 mg/dL (normal range: 200–400 mg/dL) D-dimer: >10,000 ng/mL (normal range: <500 ng/mL) Fibrin degradation products (FDPs): 40 µg/mL (normal range: <5 µg/mL) Hemoglobin: 8.5 g/dL ( normal range: 12–16 g/dL for women) Peripheral blood smear: Schistocytes Which of the following could have triggered this condition in this patient?

A 36-year-old G3 P1 pregnant woman at 34 weeks gestation presents with sudden-onset vaginal bleeding, severe abdominal pain, and uterine tenderness. Her history is significant for preeclampsia in her first pregnancy and chronic hypertension. She smokes one pack of cigarettes a day and uses cocaine occasionally. On examination, the uterus is firm and rigid on examination, and fetal heart rate monitoring shows distress. You suspect placental abruption in this patient. Which of the following is a risk factor for this disorder in this patient?

A 24-year-old woman presents to her gynecologist with complaints of persistent fatigue, and mild pelvic pain. She also mentions recent shortness of breath and a mild cough over the past two weeks. She denies fever, abdominal swelling, or recent pregnancies. On physical examination, she appears pale but stable. Her uterus is mildly tender on bimanual examination and appears slightly enlarged. The gynecologist orders a serum beta-hCG test, which returns markedly elevated at 125,000 IU/L. An ultrasound of the pelvis reveals a heterogeneous, highly vascular mass in the uterine cavity. A chest X-ray reveals multiple nodular lesions in both lungs. Biopsy reveals dimorphic neoplasm characterized by mononucleate cytotrophoblast and intermediate trophoblast, intimately admixed with multinucleate syncytiotrophoblast. The lesion shows prominent hemorrhage due to its extensive pseudovascular network. It also has central necrosis. Which of the following symptoms is most commonly associated with this neoplasm?

A 26-year-old woman presents to her gynecologist with complaints of intermittent vaginal bleeding, persistent fatigue, and mild pelvic pain. She also mentions recent shortness of breath and a mild cough over the past two weeks. She denies fever, abdominal swelling, or recent pregnancies. On physical examination, she appears pale but stable. Speculum examination reveals dark blood in the vaginal canal with no visible lesions. Her uterus is mildly tender on bimanual examination and appears slightly enlarged. The gynecologist orders a serum beta-hCG test, which returns markedly elevated at 125,000 IU/L. An ultrasound of the pelvis reveals a heterogeneous, highly vascular mass in the uterine cavity. A chest X-ray reveals multiple nodular lesions in both lungs. Biopsy reveals dimorphic neoplasm characterized by mononucleate cytotrophoblast and intermediate trophoblast, intimately admixed with multinucleate syncytiotrophoblast. The lesion shows prominent hemorrhage due to its extensive pseudovascular network. It also has central necrosis. Which of the following is the primary treatment for this neoplasm?