A 24 – year – old woman presents to her GP with mildly painful swelling of her right leg and acute shoness of breath. She is 32 weeks pregnant with her second child but is otherwise well and has no other medical history. With regard to this which of the following statement is NOT true?
First, the core concept is likely deep vein thrombosis (DVT) leading to pulmonary embolism (PE). Pregnancy increases the risk of thromboembolism due to hypercoagulable state. The swelling in the leg and sudden SOB point towards DVT and PE as the main differential.
Now, the question asks which statement is NOT true. Let's consider the options. The correct answer would be the one that contradicts known facts about this scenario. For example, if an option says that anticoagulation is contraindicated in pregnancy, that's false because low molecular weight heparin is used. Another incorrect option might be about the timing of PE in pregnancy, like it being more common in the postpartum period, which is actually true, so if an option says it's rare postpartum, that's wrong.
The wrong options need to be evaluated. Each incorrect statement should be explained based on known medical facts. For instance, if an option claims that DVT is less common in pregnancy, that's incorrect because pregnancy is a known risk factor. Also, if an option suggests that the treatment involves warfarin, that's wrong because warfarin crosses the placenta and is teratogenic, so heparin is preferred.
The clinical pearl here is to remember that pregnancy is a hypercoagulable state, increasing the risk of DVT and PE, and management involves heparin, not warfarin, due to teratogenic risks. Also, acute SOB in a pregnant woman with leg swelling should immediately raise suspicion for PE.
**Core Concept**
Pregnancy increases the risk of deep vein thrombosis (DVT) and pulmonary embolism (PE) due to hypercoagulability, venous stasis, and pelvic vein compression. Clinical suspicion for thromboembolism should be high in pregnant patients with unilateral leg swelling and acute dyspnea.
**Why the Correct Answer is Right**
The correct answer would incorrectly state that **anticoagulation with warfarin is the first-line treatment in pregnancy**. Warfarin is teratogenic and contraindicated in pregnancy, especially during the first trimester. Instead, low molecular weight heparin (e.g., enoxaparin) is the preferred anticoagulant due to its placenta non-crossing safety profile. The clinical scenario describes classic signs of DVT/PE, and the false statement would mislead management.
**Why Each Wrong Option is Incorrect**
**Option A:** "DVT is more common in the third trimester" – True. Hypercoagulability peaks in the third trimester and postpartum period.
**Option B:** "PE is a leading cause of maternal mortality" – True. PE accounts for ~10% of maternal deaths in high-income countries.
**Option C:** "Leg swelling is a common benign finding in pregnancy" – True. Physiological edema occurs in 70–80% of pregnancies but warrants investigation if asymmetric.
**Clinical Pearl / High-Yield Fact**
**Remember the "Virchow