Physician's Assistant

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Rapidreview Thu 27 November 2025 19:45

Last Modified: 130 days ago

MRN:

Content:

ACUTE MEDICAL ASSESSMENT

Date: 27/11/2025
Patient: Georgina Neil
MRN: 966270
Age: 35 years
Gestation: 35+4 weeks, G2P1

PRESENTING COMPLAINT:
Tachycardia and shortness of breath in pregnancy. Community midwife concern regarding small for gestational age and reduced fetal movements.

HISTORY OF PRESENTING COMPLAINT:
Patient presented with heart rate initially 110 bpm at 06:00, improving to 88 bpm on review. Experienced episodes of tiredness, palpitations, and positional shortness of breath. Symptoms appear related to fetal position high on diaphragm. No chest pain. Shortness of breath occurs mainly when leaning forward, resolves when lying back. Patient reports similar issues in previous pregnancy 4 years ago with heart rate and blood pressure fluctuations which resolved without treatment.

Symptoms potentially related to gestational diabetes screening (tested Monday) include fatigue, polyuria, and polydipsia, though patient attributes these to normal pregnancy symptoms.

PAST MEDICAL HISTORY:
Previous pregnancy with similar heart rate/BP issues - resolved spontaneously
Planned caesarean section for current pregnancy

OBSTETRIC HISTORY:
G2P1, 35+4 weeks gestation
Growth scan today showing accelerated growth velocity but fetal measurements within normal limits
Planned caesarean section

INVESTIGATIONS:
Bloods: CRP 1, Hb 113 g/L (previously 115), K+/Na+/Urea normal, WCC normal
ECG: Sinus rhythm, rate 88 bpm, no changes associated with PE, P mitrale seen in lead I
Vital signs: HR 88 bpm (improved from 110), T 36.7°C, RR 20, BP 130/86, SaO2 98%
Gestational diabetes screening: Results pending

EXAMINATION:
General: Well-appearing pregnant female, comfortable at rest
Cardiovascular: Heart sounds normal, no murmurs
Respiratory: Chest clear but quiet bases bilaterally, consistent with pregnancy
Abdomen: Distended in keeping with 35+4 weeks gestation
Lower limbs: No calf pain, swelling, or redness. Patient monitoring for signs of DVT

IMPRESSION:
Very unlikely pulmonary embolism. Tachycardia now resolved. No ECG changes associated with PE. Mild anaemia (Hb 113). Positional shortness of breath likely due to fetal position and diaphragmatic compression.

PLAN:
1. Discharge home with safety netting
2. Strong advice to return if persistent tachycardia, worsening shortness of breath, syncope, or chest pain
3. Iron supplementation for mild anaemia - continue pregnancy vitamins
4. Follow up gestational diabetes screening results
5. Routine obstetric follow-up continues
6. Patient advised regarding increased VTE risk in pregnancy and post-partum period

Patient declined further investigation (CT-PA) which is reasonable given clinical picture and resolved tachycardia.

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Rapidreview Thu 27 November 2025 19:45

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