During a 4-week postpartum checkup, the woman tells the clinic nurse that she is still bleeding. The nurse notes the presence of lochia rubra and a fundal height midway between the umbilicus and symphysis pubis
The nurse suspects late postpartum hemorrhage, most likely as a result of:
a. An undetected cervical laceration
b. Subinvolution of placental site
c. A coagulation disorder
d. Defective vascularity of the decidua
ANS: B
Subinvolution of the uterus occurs when the uterus fails to return to its pre-pregnant size. It remains enlarged and still has a lochial discharge. Subinvolution may result from a small retained placental fragment or mild endometritis.
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