Retained products of conceptionMANAGEMENT

SYSTEMIC AND MISCELLANEOUS PRESENTATIONS · 12 SECTIONS

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171 items

☷ Legend

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Cardiovascular Presentations66▾

Respiratory Presentations47▾

Neurological Presentations77▾

Gastrointestinal Presentations63▾

Genitourinary and Reproductive Presentations44▾

Infectious Disease Presentations146▾

Trauma Presentations88▾

Toxicologic Presentations67▾

Psychiatric Presentations25▾

Musculoskeletal and Rheumatologic Presentations89▾

Dermatology Presentations21▾

Environmental and Exposure Presentations26▾

Hematologic and Oncologic Presentations30▾

Pediatric-Specific Presentations13▾

Endocrine and Metabolic Presentations42▾

ENT and Maxillofacial Presentations21▾

Ophthalmologic Presentations15▾

Obstetric Presentations17▾

Systemic and Miscellaneous Presentations15▾

Allergic Transfusion Reaction Anaphylaxis Angioedema Benedikt's Syndrome Cannabis-induced hyperemesis Eczema (acute flare)Gradenigo's Syndrome Horner's Syndrome (Acute)Huntington's Disease (Acute Presentation)Kanavel's Signs Lemierre's Syndrome Radiation exposure Retained products of conception Sever's Disease Urticaria

01Approach to the Critical Patient/attcp16

Initial Priorities

›Hemodynamic stability assessment

›Active vaginal bleeding

›Hypotension or tachycardia

›Signs of hypovolemic shock

›Sepsis risk stratification

›Fever or hypothermia

›Altered mental status

›Elevated lactate

›Obstetric emergency triggers

›Postpartum hemorrhage

›Suspected uterine infection

›Retained tissue with instability

Immediate Escalation Triggers

›Clinical deterioration

›Escalate to resuscitation bay

›Activate obstetrics and anesthesia

›Massive transfusion protocol if ongoing hemorrhage

02History/hx23

Presenting Features

›Persistent vaginal bleeding

›Heavy bleeding beyond expected postpartum or post-abortion course

›Passage of tissue or clots

›Infectious symptoms

›Fever

›Chills

›Foul-smelling lochia

›Pelvic or lower abdominal pain

›Cramping

›Uterine tenderness sensation

Obstetric and Gynecologic Context

›Recent pregnancy outcome

›Vaginal delivery

›Cesarean delivery

›Spontaneous abortion

›Induced abortion

›Timing since delivery or procedure

›<24 hours

›24-72 hours

›>72 hours

›Placental delivery details

›Manual extraction

›Placenta not intact

›Known accreta spectrum risk

03Physical Exam/exam17

General and Vital Signs

›Vital sign abnormalities

›Fever

›Tachycardia

›Hypotension

›Overall appearance

›Ill or toxic appearance

›Pallor

Abdominal and Pelvic Exam

›Abdominal findings

›Suprapubic tenderness

›Guarding

›Uterine assessment

›Enlarged or boggy uterus

›Uterine tenderness

›Vaginal examination

›Active bleeding

›Retained tissue at cervical os

›Foul-smelling discharge

04Differential Diagnosis/ddx14

Postpartum and Post-Abortion Causes

›Retained products of conception

›ICD-10 O72.2

›Endometritis

›ICD-10 O86.12

›Uterine atony

›ICD-10 O72.1

›Uterine inversion

›ICD-10 O71.2

Non-Obstetric Mimics

›Coagulopathy

›Anticoagulant use

›Inherited bleeding disorder

›Genital tract trauma

›Cervical laceration

›Vaginal hematoma

05Laboratory Tests/lt10

Hematologic and Infectious Evaluation

›Complete blood count

›Hemoglobin trend for blood loss

›Leukocytosis for infection

›Serum lactate

›Tissue hypoperfusion marker

›Blood cultures

›Febrile or septic presentation

Pregnancy-Related Tests

›Serum beta-hCG

›Persistent elevation post-pregnancy

›Decline failure after abortion

06Diagnostic Tests/dt18

Scoring Systems

›No validated scoring system specific to retained products

›Diagnosis based on clinical and imaging correlation

›Expert consensus approach

Ultrasound

›Transvaginal ultrasound

›Endometrial thickness >10 mm

›Increased likelihood of retained tissue

›Echogenic intrauterine material

›Heterogeneous mass

›Doppler vascularity

›Increased flow suggesting retained placental tissue

›CT pelvis

›Reserved for unclear diagnosis

›Alternative causes of bleeding or infection

›Not first-line imaging

MRI

›MRI pelvis

›Suspected placenta accreta spectrum

›Equivocal ultrasound findings

›Preoperative planning

07Disposition/dispo11

Level of Care

›Admission criteria

›Hemodynamic instability

›Ongoing hemorrhage

›Suspected infection

›ICU admission

›Septic shock

›Massive transfusion requirement

›Discharge consideration

›Mild bleeding

›Stable vitals

›Reliable follow-up

08Treatment/t21

Medical Management

›Uterotonic therapy

›Oxytocin infusion

›Continuous IV administration

›Titration based on uterine tone

›Misoprostol

›600-800 micrograms per rectum or oral

›Antibiotic therapy

›Broad-spectrum coverage

›Ampicillin

›Gentamicin

›Clindamycin

›Indicated for suspected endometritis

Surgical Management

›Uterine evacuation

›Dilation and curettage

›Vacuum aspiration

›Interventional radiology

›Uterine artery embolization

›Refractory bleeding

›Hysterectomy

›Life-threatening hemorrhage

›Failed conservative management

09Special Populations/sp10

Pregnancy

›Placenta accreta spectrum risk

›Prior cesarean delivery

›Placenta previa

›Increased hemorrhage risk

›Early obstetric consultation

Geriatric

›Not applicable

›Condition limited to reproductive age

Pediatrics

›Adolescents

›Higher risk after unsafe abortion

›Confidential care considerations

10Background/b21

Epidemiology

›Incidence

›1-3 percent of vaginal deliveries

›Higher after second-trimester loss

›Risk factors

›Placenta accreta

›Manual placental extraction

Pathophysiology

›Incomplete placental separation

›Persistent trophoblastic tissue

›Uterine subinvolution

›Ongoing bleeding

›Bacterial overgrowth

›Progression to endometritis or sepsis

Therapeutic Considerations

›Early recognition reduces morbidity

›Hemorrhage prevention

›Infection control

›Surgical evacuation definitive treatment

›Medical therapy adjunctive

›Multidisciplinary management

›Obstetrics

›Anesthesia

›Interventional radiology

11Patient Discharge Instructions/pdi6

Copy Discharge Instructions

›Return to emergency department for heavy bleeding

›Soaking more than one pad per hour

›Return for fever or chills

›Temperature ≥38°C

›Return for worsening abdominal pain

›Follow-up with obstetrics within 24-72 hours

12References/r4

Clinical Guidelines

›American College of Obstetricians and Gynecologists Practice Bulletin on postpartum hemorrhage

›World Health Organization guidance on retained products of conception

Evidence-Based Sources

›UpToDate review on retained products of conception

›Cochrane review on management of postpartum hemorrhage

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed June 16, 2026

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