Continuous seepage of blood from the vagina in a postpartum client with a firm uterus 1 cm below the umbilicus most likely indicates which complication?

• A. Retained placental fragments
• B. Urinary tract infection
• C. Cervical laceration
• D. Uterine atony

Answer: (C)

When the uterus is firm after delivery but there is continuous vaginal bleeding, the source is usually outside the uterus. A cervix or birth canal injury can bleed steadily even though the uterus is contracting well. A cervical laceration often causes ongoing bright red bleeding that isn’t controlled by fundal massage, because the bleeding comes from the laceration itself rather than from uterine tone.

Retained placental fragments tend to produce heavy bleeding with the uterus that is soft or “boggy” because the uterus can’t contract effectively to clamp down on placental vessels. A urinary tract infection wouldn’t explain ongoing vaginal bleeding in the immediate postpartum period and typically presents with urinary symptoms and fever rather than continuous bleeding. Uterine atony would present with a soft, poorly contracting uterus and copious bleeding, not a firm uterus.

So the continuous seepage with a firm uterus is most consistent with a cervical laceration.