A 27-year-old woman presents 12 days after a vaginal delivery at term with sudden heavy bright-red vaginal bleeding. Her uterus feels 16 weeks size and softer than expected. Transabdominal ultrasound shows heterogeneous echogenic material within the endometrial cavity. She is haemodynamically stable with Hb of 9.8 g/dL. What is the definitive management?

• A Intravenous oxytocin infusion alone for 24 hours
• B Uterine balloon tamponade
• C Suction and curettage under antibiotic cover after stabilisation ✓
• D Total abdominal hysterectomy

Explanation

Secondary (delayed) postpartum haemorrhage occurs between 24 hours and 12 weeks after delivery, and retained products of conception are its commonest cause, producing a bulky soft uterus with retained echogenic tissue on ultrasound. Definitive treatment is evacuation of the uterus after resuscitation, with antibiotic cover because endometritis frequently coexists. Oxytocin infusion alone does not remove the tissue, tamponade is for primary atonic PPH, and hysterectomy is unwarranted in a stable young woman.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.