Match each clinical presentation occurring during the puerperium with its most likely underlying diagnosis.
- Excessive postpartum vaginal bleeding accompanied by a soft, poorly contracted uterus palpated above the umbilicus.Uterine atony
- Profound postpartum hemorrhagic shock, an absent uterine fundus on abdominal palpation, and a smooth mass in the vaginal canal.Uterine inversion
- Severe, escalating perineal pain following an operative vaginal delivery, accompanied by a firm uterus and a tense, purplish paravaginal swelling.Vaginal hematoma
- Fever, diffuse lower abdominal pain, and purulent, malodorous lochia developing 72 hours following a cesarean delivery.Postpartum endometritis
Answer
The clinical presentations match their respective postpartum complications based on characteristic physical exam findings: a boggy uterus indicates uterine atony, an absent abdominal fundus indicates uterine inversion, severe perineal pain with a paravaginal mass indicates a vaginal hematoma, and fever with uterine tenderness indicates postpartum endometritis.
Each postpartum complication presents with distinct, recognizable clinical findings. Uterine atony is characterized by a failure of the myometrium to contract, resulting in a soft, boggy uterus and heavy bleeding. Uterine inversion involves the fundus collapsing into the endometrial cavity, presenting with rapid shock, a vaginal mass, and an unpalpable fundus abdominally. Vaginal hematomas result from vessel injury during delivery, causing severe localized pain and swelling with a normal uterine tone. Postpartum endometritis is a polymicrobial infection manifesting as fever, uterine tenderness, and foul-smelling lochia typically 2 to 3 days after delivery.
Step-by-Step Solution
Key Concept
Major postpartum complications can be accurately differentiated by targeted physical examination findings, specifically uterine tone, fundal location, localized perineal swelling, and signs of infection.