What finding best suggests retained placenta after delivery?

• A. Ultrasound shows placental fragments after delivery.
• B. Prolonged bleeding and a boggy uterus despite massage.
• C. Fever and tachycardia without bleeding.
• D. Normal fundal size with firm uterus.

Answer: (B)

Retained placenta means placental tissue remains in the uterus after delivery. The most definitive clue is imaging that shows placental fragments still inside the uterus, such as ultrasound evidence of tissue that should have been delivered. This directly confirms the retention.

Prolonged bleeding with a boggy uterus that does not respond to fundal massage points to uterine atony—when the uterus isn’t contracting effectively. While this can accompany retained tissue, it is not by itself proof that placental fragments are present.

Fever and tachycardia without bleeding suggest an infection (endometritis) rather than retention of placental tissue, and a normal fundal size with a firm uterus is a normal postpartum finding.

So the clearest sign of retained placenta is ultrasound-detected placental fragments inside the uterus after delivery.