A 26-year-old woman presents on postpartum day 18 with heavy vaginal bleeding after a previously uncomplicated delivery. Examination shows a soft, bulky uterus. The most appropriate next step after resuscitation is:
- A Pelvic ultrasound followed by evacuation of retained products ✓
- B Uterine artery embolisation
- C Immediate hysterectomy
- D High-dose oestrogen therapy
Correct answer: A. Pelvic ultrasound followed by evacuation of retained products
Explanation
Secondary postpartum haemorrhage, defined as bleeding after 24 hours up to 6 weeks postpartum, is most commonly caused by retained products of conception with endometritis. Management is resuscitation, antibiotics, and ultrasound confirmation followed by surgical evacuation under antibiotic cover. Hysterectomy is reserved for uncontrollable haemorrhage or proven abnormal invasion such as placenta accreta spectrum, and embolisation is a second-line measure here.
Reference: Munro Kerr's Operative Obstetrics, 13th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.