Retained Products of Conception

Retention of placental or fetal tissue within the uterine cavity following delivery or pregnancy loss, predisposing to secondary postpartum hemorrhage (see that entry) and puerperal sepsis (see that entry) given the tissue serving as a nidus for infection and preventing full uterine involution.

Clinical suspicion based on the history and examination (a uterus larger than expected for the time since delivery, or an open cervical os with bleeding)
Pelvic ultrasound, though interpretation postpartum can be challenging given normal variability in endometrial appearance during involution, an endometrial thickness that is thin and echogenically normal makes significant retained tissue less likely, while a thickened or heterogeneous endometrial collection supports the diagnosis
FBC and inflammatory markers if infection is suspected; blood cultures if systemically unwell

Surgical evacuation (ultrasound-guided suction curettage) is the definitive treatment for significant retained tissue, particularly with ongoing bleeding
Expectant management may be appropriate for small amounts of retained tissue without significant bleeding, with resolution and repeat ultrasound to confirm
Antibiotics if infection is present or suspected (see Puerperal Sepsis entry for regimen)
Uterotonics (oxytocin, or misoprostol 600 to 800 mcg PO/PV) may reduce bleeding while awaiting definitive management or as an adjunct to expectant management
Anti-D prophylaxis for Rh negative women undergoing surgical evacuation

Referral: gynecology or obstetrics for surgical evacuation.

Clinical toolsCalculators

BMI GCS EDD Parkland Formula

Corrected Sodium Corrected Calcium Anion Gap Creatinine Clearance Insulin Calculations qSOFA Wells PE Wells DVT CHA₂DS₂-VASc HAS-BLED CURB-65 Centor/McIsaac

Postpartum Endometritis

Infection of the endometrium (and often the myometrium and parametrial tissue) following delivery, more common after cesarean section (roughly 5 to 10 times the risk compared with vaginal delivery) than vaginal birth, and further increased by prolonged labor, prolonged rupture of membranes, multiple vaginal examinations, and retained products of conception.

Typically polymicrobial, reflecting ascending genital tract flora.

Primarily clinical, based on the combination of fever, uterine tenderness, and abnormal lochia in the appropriate postpartum timeframe. FBC (leukocytosis), CRP, blood cultures, and high vaginal/endocervical swabs support diagnosis and guide any subsequent antibiotic adjustment, though empirical treatment should not be delayed pending results. Pelvic ultrasound if retained products of conception is suspected as a contributing or complicating factor.

IV antibiotics: a commonly used regimen is IV clindamycin 900 mg tds plus gentamicin (dosed by weight, typically 5 to 7 mg/kg once daily with renal function monitoring), reflecting good coverage of the typical polymicrobial, including anaerobic, flora; alternatives include IV co-amoxiclav 1.2 g tds, per local protocol and severity
Continue IV antibiotics until the woman is afebrile and clinically improving for at least 24 to 48 hours, then no routine need for a further oral course in most straightforward cases, per current evidence, though practice varies by local protocol
Evaluate for and manage retained products of conception if identified (see that entry) as a contributing factor requiring specific evacuation
Analgesia and supportive care
Escalate per the Puerperal Sepsis entry if features of systemic sepsis or failure to respond to initial antibiotics develop

Referral: obstetric-led inpatient management; gynecology input if surgical evacuation of retained products is needed.

Retained Products of Conception

Overview

Clinical Features

Diagnosis

Management

Overview

Clinical Features

Diagnosis

Management