Which factor most increases risk for postpartum thromboembolism?

• A. A 39-year-old smoker
• B. A 24-year-old vegetarian, thin
• C. A 30-year-old multiparous, normal weight
• D. A 22-year-old first pregnancy with past oral contraceptives

Answer: (A)

In the postpartum period, blood is more prone to clotting due to a natural hypercoagulable state and venous stasis from the uterus. Factors that heighten this risk include advanced maternal age and smoking, which promotes platelet activation and vasoconstriction. A 39-year-old smoker combines these strongest risks, making her the most likely to develop a postpartum thromboembolism among the scenarios. The younger, healthy individual and the multiparous but normal-weight case carry less risk, and prior oral contraceptive use adds some risk but not as much as the combination of older age and smoking in this context.