A 22-year-old primigravida with a dichorionic-diamniotic twin pregnancy at 26 weeks gestation presents with sudden onset dyspnoea and hypotension. Her oxygen saturation falls to 84%. She had no prodromal symptoms. Electrocardiogram shows an S1Q3T3 pattern. The MOST likely diagnosis is:
- A Amniotic fluid embolism
- B Pulmonary thromboembolism ✓
- C Peripartum cardiomyopathy
- D Aspiration pneumonitis
Correct answer: B. Pulmonary thromboembolism
Explanation
Pulmonary thromboembolism (PTE) classically presents with sudden dyspnoea, pleuritic chest pain, and hypoxia. The S1Q3T3 pattern on ECG (S wave in lead I, Q wave and T-wave inversion in lead III) is the classic ECG finding. Pregnancy is a hypercoagulable state, and twin pregnancy further increases the risk. Amniotic fluid embolism typically occurs during or immediately after delivery. Peripartum cardiomyopathy presents insidiously with heart failure in the last month of pregnancy or postpartum.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.