A 30-year-old woman presents 3 weeks after an uncomplicated vaginal delivery with heavy vaginal bleeding. Ultrasound shows heterogeneous echogenic material within the endometrial cavity with Doppler flow. Her pulse is 104/min and hemoglobin is 8.5 g/dL. The most common cause of this presentation is:
- A Uterine arteriovenous malformation
- B Endometritis alone
- C Retained products of conception ✓
- D Subinvolution of placental site vessels
Correct answer: C. Retained products of conception
Explanation
Retained products of conception are the commonest cause of secondary PPH, presenting with bleeding and often fever and subinvolution; ultrasound shows echogenic intrauterine tissue, and Doppler flow supports retained tissue rather than avascular clots. Endometritis may accompany it but rarely causes heavy bleeding alone. Arteriovenous malformation is rare and shows high-velocity turbulent flow, while subinvolution of the placental site is a diagnosis made after histological exclusion of retained tissue.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.