Question

The nurse in a maternity unit is reviewing the clients' records. Which client would the nurse identify as being at the most risk for developing disseminated intravascular coagulation?

1. A primigravida with mild preeclampsia
2. A primigravida who delivered a 10-lb infant 3 hours ago
3. A gravida II who has just been diagnosed with dead fetus syndrome
4. A gravida IV who delivered 8 hours ago and has lost 500 mL of blood

Answer 1

The gravida II diagnosed with dead fetus syndrome is at the highest risk for developing disseminated intravascular coagulation due to the release of thromboplastin from the dead fetal tissue, triggering excessive clotting in the mother's circulation.

Step-by-step explanation:

The client who would be identified as being at the most risk for developing disseminated intravascular coagulation (DIC) is the gravida II who has just been diagnosed with dead fetus syndrome. This condition involves retention of a deceased fetus and can lead to a massive activation of the coagulation cascade, possibly resulting in DIC. Factors that place this client at high risk include the release of thromboplastin from the dead fetal tissue into the mother's circulation, which can trigger widespread clotting. This excessive clotting can deplete the body's supply of platelets and clotting factors, leading to bleeding (consumptive coagulopathy) and can potentially cause organ damage due to impaired circulation.

Conditions such as preeclampsia and significant postpartum hemorrhage (as seen in the primigravida who delivered a 10-lb infant and the gravida IV who lost 500 mL of blood, respectively) can also be associated with DIC, but the gravida II with dead fetus syndrome presents an immediate and high risk for this serious complication.