Fourteen days after a normal vaginal delivery, a woman presents with brisk bright-red vaginal bleeding and intermittent lower abdominal cramps. She is afebrile. Ultrasound shows an echogenic mass within the uterine cavity. The most likely cause is:

• A Subinvolution of the placental site
• B Uterine artery pseudoaneurysm
• C Retained products of conception ✓
• D Inherited coagulation disorder

Explanation

Secondary postpartum hemorrhage between 24 hours and 6 weeks is caused by retained products with associated endometritis in the great majority of cases; the echogenic intracavitary mass on ultrasound confirms this, and management is antibiotics followed by evacuation. Subinvolution is the diagnosis when bleeding occurs with an empty, bulky uterus. Pseudoaneurysm is rare, suggested by pulsatile bleeding and treated by embolization, while coagulation disorders usually declare themselves earlier.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.