A woman delivered vaginally 18 days ago reports continued reddish vaginal discharge. Examination shows a uterus slightly larger than expected for the puerperal period. What is the most likely cause of this persistent red lochia?
- A Normal lochia alba
- B Physiological lactational discharge
- C Retained products of conception causing subinvolution ✓
- D Cervical ectopy of pregnancy
Correct answer: C. Retained products of conception causing subinvolution
Explanation
Lochia rubra normally lasts 3 to 4 days and is replaced by serous then white lochia; red discharge persisting beyond 2 weeks indicates subinvolution, classically due to retained placental fragments or endometritis. Lochia alba is whitish and appears around day 10, so option A contradicts the finding. Lactational discharge is milky, not bloody. Cervical ectopy may cause spotting but does not produce an enlarged subinvoluted uterus. Management is evacuation of retained products with antibiotic cover.
Reference: DC Dutta's Textbook of Obstetrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.