Puerperal woman is more susceptible to venous thrombosis due to?

SJH Nursing Officer - 2019

Obstetrics & Gynaecology

Medium

Appeared in: SJH Nursing Officer - 2019

Explanation

The postpartum period is a high-risk time for venous thromboembolism (VTE) due to a combination of factors known as Virchow's triad.
Venous stasis, or the slowing of blood flow, is a major contributor. This is directly caused by immobility, bed rest, and delayed ambulation after delivery.
During pregnancy, the enlarged uterus compresses pelvic veins, reducing venous return from the legs. This effect can persist into the early postpartum period.
Late ambulation allows blood to pool in the lower extremities, significantly increasing the risk of clot formation in the deep veins.
Early ambulation is a key nursing intervention because it counteracts stasis and is a cornerstone of VTE prevention.

Option A: While dehydration can increase blood viscosity and is a contributing risk factor for thrombosis, it is not considered the primary cause in the postpartum period. The physiological state of hypercoagulability and venous stasis are more significant drivers.
Option B: This statement is factually incorrect. Pregnancy and the puerperium are characterized by hypercoagulability, meaning an increased tendency to clot and effectively increased blood 'viscosity' in terms of clotting potential, not decreased.
Option D: Increased fat intake is a chronic, long-term risk factor for atherosclerosis and cardiovascular disease. It is not an acute cause of venous thrombosis in the immediate postpartum period.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Pathophysiology of Postpartum Venous Thromboembolism (VTE) as background academic context rather than a clinical decision trigger.
Nurses play a critical role in preventing postpartum VTE, a leading cause of maternal mortality. The primary nursing intervention is promoting early and frequent ambulation.
Assessment for signs of DVT (unilateral leg swelling, pain, warmth, redness) and PE (sudden shortness of breath, chest pain, tachycardia) is a vital nursing responsibility. Prompt escalation is required if these signs appear.
Patient education on preventive measures (leg exercises, hydration, avoiding leg crossing) and signs/symptoms to report is essential for patient safety after discharge.

How to Approach the Question

First, identify the key elements of the question: the patient is a 'puerperal woman' (postpartum) and the condition is 'venous thrombosis'.
Recall the underlying pathophysiology for venous thrombosis, which is Virchow's triad: 1) venous stasis, 2) hypercoagulability, and 3) endothelial injury.
Analyze each option to see how it fits within Virchow's triad in the context of a postpartum woman.
Option A (dehydration) relates to hypercoagulability but is a general factor, not the most specific postpartum cause.
Option B (decreased viscosity) is incorrect; the postpartum state is hypercoagulable.
Option C (stasis due to late ambulation) directly addresses the 'venous stasis' component of the triad, a major and modifiable risk factor in the postpartum period.

Concept Tested & Keywords

Qj0jRdhwx9-2V9QJ9wklgq

E6 Obstetrics Williams p. 92-95

E6 Medicine Harrison 22e Part 1 p. 982-984