A woman presents on day 12 postpartum with bright red vaginal bleeding heavier than her lochia had been. Her uterus is larger than expected for the puerperium and slightly tender. Pelvic ultrasound shows heterogeneous echogenic material within the endometrial cavity. The most likely cause of this secondary postpartum haemorrhage is:

• A Cervical laceration extending into the lower segment
• B Uterine artery pseudoaneurysm rupture
• C Retained products of conception with endometritis ✓
• D Coagulation factor deficiency unmasked after delivery

Explanation

Secondary postpartum haemorrhage is bleeding after the first 24 hours up to 6 weeks postpartum, and its most common cause is retained products of conception, usually complicated by endometritis. The subinvolved tender uterus plus echogenic intrauterine material on ultrasound confirm retained tissue. Cervical lacerations bleed immediately after delivery, not on day 12, and pseudoaneurysm is a rare cause without intrauterine debris.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.