A nurse is caring for a client who is at 37 weeks of gestation.
Which of the following findings should the nurse identify as a risk factor for placental abruption?

Choice A rationale

Mild thrombocytopenia, defined as a platelet count between 100,000 and 150,000/mm (normal range 150,000 to 450,000/mm), is common in pregnancy and often referred to as gestational thrombocytopenia. It is not a classic indicator of thrombophilia, which is a condition of excessive clotting rather than low platelet counts. While some autoimmune conditions like antiphospholipid syndrome can feature low platelets, isolated mild thrombocytopenia usually warrants observation rather than comprehensive thrombophilia screening unless other clinical symptoms are present.

Choice B rationale

A first-degree relative with Factor V Leiden is a significant indication for thrombophilia testing. Factor V Leiden is an autosomal dominant genetic mutation that makes the Factor V protein resistant to inactivation by activated protein C. This significantly increases the risk of venous thromboembolism during pregnancy, a naturally hypercoagulable state. Since the mutation is inherited, a maternal history of this specific factor strongly suggests the client may also carry the gene, necessitating diagnostic testing.

Choice C rationale

While a father having a pulmonary embolism indicates a family history of thrombosis, it is less specific for inherited thrombophilia than a confirmed genetic diagnosis like Factor V Leiden. A pulmonary embolism can be caused by acquired factors such as surgery, immobilization, or smoking. While it increases suspicion, clinical guidelines often prioritize testing when the family member's clot occurred at a young age or was unprovoked, or when a specific hereditary clotting mutation has already been identified in the family.

Choice D rationale

Von Willebrand disease is a bleeding disorder characterized by a deficiency or dysfunction of von Willebrand factor, which is necessary for platelet adhesion. It is the opposite of thrombophilia, which involves excessive clotting. While a family history of bleeding disorders is important for managing delivery and postpartum hemorrhage risks, it does not warrant testing for thrombophilia. Normal von Willebrand factor levels increase during pregnancy, which may temporarily mask mild forms of this specific bleeding disorder.

Choice A rationale

Referral to a diabetes mellitus educator is not a standard or necessary part of hyperthyroidism management unless the client also has a concurrent diagnosis of diabetes. While both are endocrine disorders, their management strategies are entirely different. Hyperthyroidism focuses on regulating thyroid hormone production and cardiac symptoms, whereas diabetes focuses on glucose monitoring and insulin sensitivity. Therefore, this referral would be inappropriate and irrelevant for a client specifically seeking help for hyperthyroidism.

Choice B rationale

Management of hyperthyroidism during pregnancy is complex and requires specialized knowledge to balance maternal health with fetal safety. Endocrinologists are experts in hormonal regulation and are best equipped to manage medications like propylthiouracil or methimazole, which carry specific risks at different gestations. Collaborative care between the obstetrician and an endocrinologist ensures that thyroid levels are maintained in the high-normal range to avoid fetal hypothyroidism while preventing maternal thyrotoxicosis or thyroid storm.

Choice C rationale

Hyperthyroidism does not necessarily resolve after giving birth. In fact, many clients with Graves' disease may experience a significant flare-up or "rebound" of symptoms in the postpartum period as the immune system recovers from the pregnancy-induced state of suppression. While some temporary forms of gestational thyrotoxicosis might subside, true hyperthyroidism usually requires ongoing monitoring and treatment long after delivery. Assuming it will resolve spontaneously is scientifically inaccurate and potentially dangerous for the mother.

Choice D rationale

Monitoring thyroid-stimulating hormone (TSH) and free T4 levels twice per month is generally excessive for a stable client. The standard of care typically involves testing every 2 to 4 weeks initially, then moving to every 4 to 6 weeks once the client is euthyroid. Normal TSH levels in pregnancy are often lower than non-pregnant ranges (0.1 to 2.5 mIU/L in the first trimester). Over-testing can lead to unnecessary medication adjustments and does not follow standard clinical guidelines.