Approach to the Critical Patient

Initial Priorities

Hemodynamic stability assessment

Sepsis risk stratification

Obstetric emergency triggers

Immediate Escalation Triggers

Clinical deterioration

History

Presenting Features

Persistent vaginal bleeding

Infectious symptoms

Pelvic or lower abdominal pain

Obstetric and Gynecologic Context

Recent pregnancy outcome

Timing since delivery or procedure

Placental delivery details

Physical Exam

General and Vital Signs

Vital sign abnormalities

Overall appearance

Abdominal and Pelvic Exam

Abdominal findings

Uterine assessment

Vaginal examination

Differential Diagnosis

Postpartum and Post-Abortion Causes

Retained products of conception

Endometritis

Uterine atony

Uterine inversion

Non-Obstetric Mimics

Coagulopathy

Genital tract trauma

Laboratory Tests

Hematologic and Infectious Evaluation

Complete blood count

Serum lactate

Blood cultures

Pregnancy-Related Tests

Serum beta-hCG

Diagnostic Tests

Scoring Systems

No validated scoring system specific to retained products

Ultrasound

Transvaginal ultrasound

CT

CT pelvis

MRI

MRI pelvis

Disposition

Level of Care

Admission criteria

ICU admission

Discharge consideration

Treatment

Medical Management

Uterotonic therapy

Antibiotic therapy

Surgical Management

Uterine evacuation

Interventional radiology

Hysterectomy

Special Populations

Pregnancy

Placenta accreta spectrum risk

Increased hemorrhage risk

Geriatric

Not applicable

Pediatrics

Adolescents

Background

Epidemiology

Incidence

Risk factors

Pathophysiology

Incomplete placental separation

Uterine subinvolution

Bacterial overgrowth

Therapeutic Considerations

Early recognition reduces morbidity

Surgical evacuation definitive treatment

Multidisciplinary management

Patient Discharge Instructions

Copy Discharge Instructions

Return to emergency department for heavy bleeding

Return for fever or chills

Return for worsening abdominal pain

Follow-up with obstetrics within 24-72 hours

References

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

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.