A pregnant client at 32 weeks gestation is admitted with severe preeclampsia and develops disseminated intravascular coagulation (DIC). Laboratory results show: platelets 45,000/mm³, fibrinogen 80 mg/dL, D-dimer elevated, PT/PTT prolonged. The client is experiencing vaginal bleeding. What is the priority nursing intervention?
1Administer fresh frozen plasma as prescribed
2Apply firm pressure to all bleeding sites
3Monitor vital signs every 15 minutes
4Prepare for emergency delivery and notify the physician immediately✓ 정답
해설
DIC in pregnancy is a life-threatening emergency requiring immediate delivery to remove the placental source of coagulopathy. Other interventions are supportive but secondary to addressing the underlying cause.
Understanding the Pathophysiology: Why Delivery is the Priority
In severe preeclampsia, the underlying pathology is widespread endothelial dysfunction and intense vasospasm, as highlighted in the research on DIC in preeclampsia [1]. This damaged endothelium triggers a cascade of events that can lead to disseminated intravascular coagulation (DIC). The laboratory values presented here paint a clear picture of this life-threatening consumptive coagulopathy: a critically low platelet count of 45,000/mm³ (thrombocytopenia), a depleted fibrinogen level of 80 mg/dL, elevated D-dimer indicating active clot breakdown, and prolonged PT/PTT signifying widespread clotting factor consumption. The patient is simultaneously clotting and bleeding, a dangerous paradox.
The priority intervention is to prepare for emergency delivery and notify the physician immediately. The rationale is rooted in the definitive treatment for severe preeclampsia and its complications, including DIC: removal of the placenta. The placenta is the diseased organ releasing factors that perpetuate the maternal endothelial dysfunction and vasospasm [1]. All other interventions, while important, are temporizing measures that manage the consequences of the disease without addressing the source. An international registry on DIC in pregnancy confirms this condition is a severe maternal morbidity associated with significant short- and long-term complications, underscoring the urgency of definitive management [3]. Without delivery, the pathologic process will continue unabated, leading to further consumption of clotting factors, worsening hemorrhage, and potential end-organ damage, most commonly affecting the brain, kidneys, and uterus [1].
Analyzing the Other Options in the Clinical Context
- Option 1: Administer fresh frozen plasma as prescribed. Replacing consumed clotting factors with fresh frozen plasma is a critical component of DIC management. However, it is a supportive measure, not the definitive treatment. In the context of a 32-week gestation with severe preeclampsia, transfusing blood products without simultaneously moving toward delivery is like pouring fluid into a bucket with a large hole. The ongoing consumption driven by the placental pathology will rapidly deplete the replaced factors, providing only transient benefit [3].
- Option 2: Apply firm pressure to all bleeding sites. This is a fundamental nursing intervention for controlling external hemorrhage and is appropriate to implement. Nevertheless, it addresses only one manifestation of the DIC (vaginal bleeding) and does not halt the underlying consumptive process. The patient is at risk for internal bleeding and microthrombi formation in vital organs, which local pressure cannot control [1].
- Option 3: Monitor vital signs every 15 minutes. Frequent monitoring is essential for detecting hemodynamic instability from hemorrhage and for assessing the severity of preeclampsia (e.g., worsening hypertension). This is a core nursing responsibility. However, assessment alone does not alter the trajectory of the disease. The priority is the action that will stop the pathologic process, making delivery the most critical intervention to communicate and prepare for .
The clinical prediction research on DIC in placental abruption reinforces that the development of DIC significantly worsens maternal outcomes . In severe preeclampsia, the principle is the same. The nurse’s priority is to recognize that the patient’s condition is a “time-sensitive emergency” where definitive therapy is delivery. Therefore, immediately notifying the physician and preparing the patient and the operating room for an emergency cesarean section is the action that directly leads to resolution of the disease process and provides the best chance for maternal and fetal survival .
References (research sources)
[1]
D-Dimer: An Early Marker of Disseminated Intravascular Coagulation in Preeclampsia and Eclampsia.Research articleSinha R, Joshi H, Das M, Bhardwaj R. (2025) · DOI: 10.7759/cureus.98809
[3]
Disseminated intravascular coagulopathy in pregnancy: lessons from an international registry of the International Society for Thrombosis and Hemostasis: communication from the SSC of the ISTH.Research articleErez O, Besser L, Dayan Schwartz A, Illanes S, Quezada B, Othman M, Kadir RA, Iba T, Sidonio R, Scarlatescu E, Thachil J. (2026) · DOI: 10.1016/j.jtha.2026.06.030
Clinical Scenario
A 32-week pregnant client with severe preeclampsia develops DIC with active vaginal bleeding. Labs: platelets 45,000/mm³, fibrinogen 80 mg/dL, elevated D-dimer, prolonged PT/PTT.
Pathophysiology & Rationale
Severe preeclampsia causes widespread endothelial injury and vasospasm. The damaged endothelium triggers uncontrolled activation of the coagulation cascade, consuming platelets and clotting factors (consumptive coagulopathy). This paradoxically leads to both microthrombi and hemorrhage. The placenta is the diseased organ driving this process; its removal is the only definitive treatment to halt the underlying pathology. All other interventions are supportive temporizing measures.
Priority Nursing Actions
Immediate: Notify the physician and prepare for emergency delivery (cesarean or induction). This addresses the root cause.
Simultaneous Support: Administer blood products (FFP, platelets) as prescribed to correct coagulopathy. Apply firm pressure to bleeding sites. Monitor vital signs, oxygen saturation, and fetal heart rate continuously.
Ongoing: Assess for signs of worsening DIC (petechiae, oozing from IV sites, hematuria). Maintain strict intake and output; monitor for pulmonary edema and renal failure.
Safety & Documentation
Ensure large-bore IV access and type/crossmatch for blood products.
Document all bleeding, vital signs, and interventions in real time.
Prepare for potential neonatal resuscitation team presence at delivery.
Disseminated Intravascular Coagulation (DIC) — A life-threatening consumptive coagulopathy where widespread clotting depletes platelets and clotting factors, leading to simultaneous thrombosis and hemorrhage.
Severe Preeclampsia — A hypertensive disorder of pregnancy characterized by endothelial dysfunction and vasospasm, which can progress to multi-organ damage and DIC.
Consumptive Coagulopathy — A state where uncontrolled activation of the coagulation cascade uses up platelets and clotting factors, resulting in bleeding.
Fibrinogen — A clotting factor consumed during DIC; a low level (e.g., 80 mg/dL) indicates severe depletion and high bleeding risk.
Placenta as Etiology — In preeclampsia, the placenta releases factors that cause maternal endothelial dysfunction; delivery is the only definitive cure.