A G3P2 woman delivers by SVD. Uterus is well contracted after oxytocin, placenta is complete, but vaginal bleeding continues at 700 mL. On examination, cervical lacerations are not visible. Continued bright red bleeding with clots suggests which cause?

• A Retained placental fragment ✓
• B Uterine atony with incomplete uterine contraction
• C DIC secondary to amniotic fluid embolism
• D Coagulation failure due to von Willebrand disease

Explanation

When the uterus is well contracted (tone is normal), bright red bleeding with clots continuing after delivery of a seemingly complete placenta points to a retained placental fragment preventing full uterine contractility in that segment. DIC from AFE would present with non-clotting, ooze from venipuncture sites, systemic collapse, and respiratory distress. von Willebrand disease causes mucosal bleeding but is usually known pre-delivery. The clot formation rules out primary coagulopathy.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.