A 35-year-old woman was 38 weeks pregnant with
twins (G3P2). When she developed acute onset of shortness of breath
and hemoptysis (coughing up blood), her husband called 911. Shortly
after paramedics arrived, the patient experienced a respiratory and
cardiac arrest. CPR was administered, and she successfully regained
a pulse. Upon hospital arrival, the patient was rushed to the
operating room for emergency C-section. Two infants were delivered
stillborn, with Apgar scores of 0 at 1, 5, and 10 minutes. The
patient was transferred to the ICU with hypoxic encephalopathy; she
Review of her medical records revealed that the
patient had a history of chronic hypertension, which had worsened
during her third trimester; it had been managed by increasing the
dose of her chronic antihypertensive medication (labetalol). A few
weeks prior to admission, after the patient complained of shortness
of breath, her obstetrician prescribed her albuterol. Two days
prior to admission, the patient presented to the obstetrics clinic
with blood pressures (BPs) in the range of 170-210/100-125. Fetal
non-stress testing was normal. At that visit, the nursing notes
indicate some concern about preeclampsia. However, the physician
did not order further evaluation, in part because "preeclampsia
labs" had recently been performed and were found normal.
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