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Secondary postpartum haemorrhage — DRCOG MCQ

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HardPostnatalSecondary postpartum haemorrhageDRCOG

A 30-year-old woman presents 9 days after a vaginal birth with heavy bleeding, offensive lochia and lower abdominal pain. Her temperature is 38.2°C and pulse is 112/min. What is the most likely diagnosis?

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Correct answer: C — Secondary postpartum haemorrhage with endometritis

Heavy bleeding after 24 hours and up to 12 weeks postpartum suggests secondary postpartum haemorrhage; fever, pain and offensive lochia point to endometritis. Normal lochia should not cause systemic features or heavy fresh bleeding. The clinical pearl is that infection and retained products commonly coexist in secondary postpartum haemorrhage.

Reference: NICE NG194; RCOG Green-top Guideline No. 52