Retained products of conceptionMANAGEMENT

SYSTEMIC AND MISCELLANEOUS PRESENTATIONS · 12 SECTIONS

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173 items

☷ Legend

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Cardiovascular Presentations71▾

Respiratory Presentations52▾

Neurological Presentations83▾

Gastrointestinal Presentations74▾

Genitourinary and Reproductive Presentations48▾

Infectious Disease Presentations148▾

Trauma Presentations89▾

Toxicologic Presentations80▾

Psychiatric Presentations26▾

Musculoskeletal and Rheumatologic Presentations96▾

Dermatology Presentations23▾

Environmental and Exposure Presentations27▾

Hematologic and Oncologic Presentations36▾

Pediatric-Specific Presentations19▾

Endocrine and Metabolic Presentations45▾

ENT and Maxillofacial Presentations27▾

Ophthalmologic Presentations19▾

Obstetric Presentations23▾

Systemic and Miscellaneous Presentations17▾

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 Procedural sedation Radiation exposure Retained products of conception Sever's Disease Urticaria Venous air embolism

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/r6

Clinical Guidelines

›Key sources

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

›World Health Organization guidance on retained products of conception

Evidence-Based Sources

›Key sources

›UpToDate review on retained products of conception

›Cochrane review on management of postpartum hemorrhage

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed August 18, 2026

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