A client at 36 weeks who begins labor after an eclamptic seizure. The nurse should assess for which complication?

A client at 36 weeks who begins labor after an eclamptic seizure. The nurse should assess for which complication?

• A. Abruption placentae
• B. Placenta previa
• C. Uterine rupture
• D. DIC

Answer: (C)

When eclampsia is present and labor begins, the most critical complication to monitor for is a disseminated intravascular coagulation (DIC) picture arising from obstetric coagulopathy. Severe preeclampsia/eclampsia can provoke widespread activation of the coagulation system driven by placental pathology, leading to consumption of platelets and clotting factors. This can quickly result in serious bleeding or thrombosis if not recognized and managed promptly. So, the nurse should assess for signs of evolving coagulopathy: increasing vaginal bleeding, oozing from IV sites or gums, easy bruising, or petechiae; and order/look for lab indicators such as low platelets, prolonged PT and aPTT, low fibrinogen, and elevated D-dimer. Clinical priorities include stabilizing the mother, continuing seizure precautions and magnesium therapy, and preparing for delivery to remove the source of the coagulopathy, with blood products as indicated (platelets, fresh frozen plasma, cryoprecipitate). Uterine rupture and placenta previa/placental abruption have distinct presentations (sudden abdominal pain with fetal distress for rupture; painless bleeding for previa; painful, rigid uterus with bleeding for abruption). While they are serious, the immediate, high-priority concern in this scenario is the risk of DIC from severe preeclampsia/eclampsia.

When eclampsia is present and labor begins, the most critical complication to monitor for is a disseminated intravascular coagulation (DIC) picture arising from obstetric coagulopathy. Severe preeclampsia/eclampsia can provoke widespread activation of the coagulation system driven by placental pathology, leading to consumption of platelets and clotting factors. This can quickly result in serious bleeding or thrombosis if not recognized and managed promptly.

So, the nurse should assess for signs of evolving coagulopathy: increasing vaginal bleeding, oozing from IV sites or gums, easy bruising, or petechiae; and order/look for lab indicators such as low platelets, prolonged PT and aPTT, low fibrinogen, and elevated D-dimer. Clinical priorities include stabilizing the mother, continuing seizure precautions and magnesium therapy, and preparing for delivery to remove the source of the coagulopathy, with blood products as indicated (platelets, fresh frozen plasma, cryoprecipitate).

Uterine rupture and placenta previa/placental abruption have distinct presentations (sudden abdominal pain with fetal distress for rupture; painless bleeding for previa; painful, rigid uterus with bleeding for abruption). While they are serious, the immediate, high-priority concern in this scenario is the risk of DIC from severe preeclampsia/eclampsia.