A 30-year-old woman presents on postpartum day 18 with heavy vaginal bleeding after a home delivery. She is hemodynamically stable. Pelvic ultrasound shows echogenic material within the endometrial cavity suggestive of retained products of conception. The most appropriate next step is:

• A Hysterectomy
• B Uterine artery embolization
• C High-dose estrogen therapy to promote endometrial regeneration
• D Suction evacuation of the uterus along with antibiotic cover ✓

Explanation

Secondary PPH is most often caused by retained products of conception with or without endometritis. In a stable patient, surgical evacuation (suction curettage) removes the source of bleeding, and antibiotics cover the accompanying infection. Hysterectomy and arterial embolization are reserved for uncontrollable hemorrhage or invasive disease such as placenta accreta. Estrogen therapy addresses Asherman-related amenorrhea, not acute secondary hemorrhage.

Reference: DC Dutta's Textbook of Obstetrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.