A patient bleeds heavily despite a firm uterus after placental delivery. What is a likely cause?

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Multiple Choice

A patient bleeds heavily despite a firm uterus after placental delivery. What is a likely cause?

When the uterus feels firm after placental delivery but heavy bleeding continues, it points away from uterine tone problems and toward tissue that remains inside the uterus. Retained placental fragments mean some placental tissue did not separate or deliver completely, so bleeding vessels in the placental bed stay open and bleed despite the uterus contracting. This is why a firm uterus fits with retained tissue as the likely cause. Placental previa involves bleeding that typically occurs before or during labor rather than after delivery, and postpartum preeclampsia would present with systemic signs and hypertension rather than a focused ongoing vaginal bleed with a firm uterus. Retained placental tissue is the classic cause of heavy postpartum hemorrhage when the uterus is firm, because the remaining tissue disrupts normal involution and continues to bleed until it’s removed.

When the uterus feels firm after placental delivery but heavy bleeding continues, it points away from uterine tone problems and toward tissue that remains inside the uterus. Retained placental fragments mean some placental tissue did not separate or deliver completely, so bleeding vessels in the placental bed stay open and bleed despite the uterus contracting. This is why a firm uterus fits with retained tissue as the likely cause.

Placental previa involves bleeding that typically occurs before or during labor rather than after delivery, and postpartum preeclampsia would present with systemic signs and hypertension rather than a focused ongoing vaginal bleed with a firm uterus. Retained placental tissue is the classic cause of heavy postpartum hemorrhage when the uterus is firm, because the remaining tissue disrupts normal involution and continues to bleed until it’s removed.

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