Which client is at most risk for postpartum thromboembolic disorders?

• A. A 39-year-old woman who reports that she smokes
• B. A 24-year-old woman with a thin frame who is a vegetarian
• C. A 30-year-old woman in her fourth pregnancy who is normal weight
• D. A 22-year-old woman in a first pregnancy who states that past oral contraceptives have not caused adverse effects

Answer: (A)

Postpartum is a time when the blood is in a naturally more coagulable state to prevent postpartum hemorrhage, which also raises the risk for thromboembolic events. The strongest risk factors include advanced maternal age, smoking, multiparity, obesity, immobility, and a personal or family history of thrombosis. Among the scenarios, the client who is 39 years old and smokes carries both an older age risk and the prothrombotic effects of tobacco, making her the highest overall risk for postpartum thromboembolic disorders. The other profiles lack as many or as strong risk factors: being thin and vegetarian doesn’t inherently raise risk; multiparity does increase risk but her age is younger and there are no additional factors listed; past oral contraceptive use by itself doesn’t persist as a postpartum risk factor after the pregnancy ends unless other risk factors are present. So the combination of advanced age and smoking makes the first client the most at risk.