severe aortic stenosis concealed by a negative history in pregnancy: a case report emphasizing the diagnostic cornerstones of history and physical examination

Pregnancy concurrent with severe underlying cardiac disease presents a substantial risk to maternal and fetal well-being. despite routine antenatal screening, patients may occasionally deny or be unaware of critical cardiac histories, complicating perioperative management and leading to catastrophic decompensation. we report the case of a 22-year-old primigravida admitted for labor with intrauterine fetal demise (iufd). the initial history was non-contributory, and the physical examination was unremarkable. following an uncomplicated delivery and regional analgesia, the patient experienced sudden hemodynamic collapse, seizure, and pulmonary edema, necessitating emergent intubation and intensive care. subsequent echocardiography revealed previously undiagnosed severe aortic stenosis (as) with a mean pressuregradient of approximately 100 mmhg. this case highlights how severe, compensated pathology can be masked by patient denial, underscoring the indispensable role of a meticulous history and physical examination as the primary diagnostic tool in obstetric anesthesia, regardless of self-reported symptoms.