A 27-year-old patient at 10 weeks gestation visited her midwife for routine checkup. She complained of digestive problems consisting of constipation, heartburn and recurring nausea. She mentioned feeling squeamish when in presence of certain foods or smells, and unusual fatigue. On examination, her vital signs were within normal range; her weight gain was satisfactory. Swelling of the ankles and slightly varicose veins were noticed.