Which hematologic change increases the risk of thromboembolism in pregnancy?
Decreased clotting factors
Increased fibrinogen levels
Reduced platelet count
Decreased white blood cell count
The Correct Answer is D
Hypercoagulability in pregnancy develops as a protective adaptation to minimize hemorrhage at delivery, but it also increases the risk of thromboembolism. There is a marked rise in fibrinogen and several clotting factors (VII, VIII, IX, X, XII), while fibrinolytic activity decreases. Normal fibrinogen levels in nonpregnant women are 200–400 mg/dL, but in pregnancy, they rise to 400–650 mg/dL. This procoagulant state peaks in the third trimester and the puerperium.
Rationale for correct answer
2. Increased fibrinogen levels contribute to the hypercoagulable state of pregnancy. Elevated fibrinogen enhances clot formation and is a major factor in increasing the risk of venous thromboembolism, which is one of the leading causes of maternal morbidity and mortality.
Rationale for incorrect answers
1. Decreased clotting factors would reduce coagulation and increase the risk of bleeding, not thrombosis. Pregnancy is characterized by increased clotting factor activity, not reduction.
3. Reduced platelet count (gestational thrombocytopenia) can occur, but it is usually mild and not enough to outweigh the hypercoagulable changes. A lower platelet count actually tends toward bleeding risk, not thromboembolism.
4. Decreased white blood cell count is not typical in pregnancy. Instead, leukocytosis (WBC up to 12,000–15,000/µL, sometimes 25,000/µL in labor) is common. White blood cell levels are not directly related to thromboembolic risk in pregnancy.
Take home points
• Pregnancy is a hypercoagulable state due to increased fibrinogen and clotting factors.
• Elevated fibrinogen levels (400–650 mg/dL) significantly increase thromboembolism risk.
• Platelet count may slightly fall, but this does not negate the hypercoagulable effect.
• Thromboembolism is a major cause of maternal morbidity and mortality, especially postpartum.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Diastasis recti abdominisis the separationof the rectus abdominismuscles along the linea alba, usually due to stretching from the enlarging uterus and hormonal effects on connective tissue. The gap may exceed 2 cm, measured at the umbilicus. It presents with a midline bulge when abdominal muscles are contracted but does not involve a true fascial defect as in hernia. Risk factors include multiparity, multiple gestations, and advanced maternal age.
Rationale for correct answer
2.Diastasis recti abdominis is specifically defined as the separation of the rectus abdominis muscles along the linea alba. It occurs due to mechanical stretching of the abdominal wall during pregnancy combined with hormonal softening of connective tissues. This makes the option scientifically accurate.
Rationale for incorrect answers
1.Pregnancy-induced hypertension is a hypertensive disorder occurring after 20 weeks of gestation, defined as blood pressure ≥140/90 mmHg on two occasions. It has no relation to abdominal muscle separation and involves vascular pathophysiology, not musculoskeletal changes.
3.Neurological disorders affecting balance involve dysfunction of the cerebellum, vestibular system, or proprioception. Diastasis recti is purely a musculoskeletal and connective tissue condition and does not affect neural pathways or balance.
4.A permanent abdominal muscle tear implies actual rupture of muscle fibers. Diastasis recti does not involve tearing but rather stretching and thinning of the linea alba with separation of muscle bellies. It may improve postpartum with exercises or persist without complications of a true tear.
Take home points
• Diastasis recti abdominis is the separation of rectus muscles along the linea alba.
• The condition is due to uterine expansion and hormonal effects on connective tissue.
• It differs from hernia and muscle tears, as no fascial defect or rupture occurs.
• Risk factors include multiple pregnancies, advanced maternal age, and increased intra-abdominal pressure.
Correct Answer is C
Explanation
Relaxinis a peptide hormonesecreted mainly by the corpus luteum, decidua, and placenta during pregnancy. It increases collagen remodelingand connective tissue elasticity, promoting relaxation of pelvic ligaments and increased joint mobility to facilitate childbirth. Relaxin levels peak in the first trimester and again near term. Normal effects also include softening of the cervix and inhibition of uterine contractions to maintain early pregnancy.
Rationale for correct answer
3.Relaxin causes relaxation and softening of pelvic ligaments and joints, especially the pubic symphysis and sacroiliac joints. This increases pelvic mobility and prepares the birth canal for labor. It also contributes to cervical ripening through collagen breakdown and connective tissue remodeling.
Rationale for incorrect answers
1.Oxytocin stimulates uterine smooth muscle contractions during labor and milk ejection from the breast. It does not influence ligament relaxation or pelvic joint mobility.
2.Prolactin is primarily involved in mammary gland development and initiation of lactation. It has no role in pelvic ligament relaxation or connective tissue changes in pregnancy.
4.Cortisol regulates metabolism and has a role in fetal lung maturation, but it does not act on pelvic ligaments or joints. Its effects are primarily catabolic and immunomodulatory, not structural relaxation.
Take home points
• Relaxin softens pelvic ligaments and joints to facilitate delivery.
• It is secreted by the corpus luteum, decidua, and placenta.
• Cervical ripening and inhibition of uterine contractions are additional effects.
• Oxytocin, prolactin, and cortisol have different physiological roles unrelated to ligament relaxation.
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