A patient at 17 weeks gestation is diagnosed as having an intrauterine fetal demise. She returns to your clinic 5 weeks later and has not had amiscarriage, although she has had some occasional spotting. This patient is at increased risk for
**Core Concept**
A patient who experiences an intrauterine fetal demise (IUFD) and then experiences a prolonged interval without miscarriage, despite occasional spotting, is at increased risk for developing a condition known as **placental retention** or **retained products of conception**. This condition occurs when the placenta or fetal membranes remain in the uterus after the fetal demise, potentially leading to complications such as infection, hemorrhage, or uterine rupture.
**Why the Correct Answer is Right**
The patient's clinical presentation of occasional spotting following IUFD suggests that the placenta or fetal membranes may not have been appropriately expelled from the uterus. This can lead to a condition where the retained products of conception can become infected, causing an **endometritis**. The increased risk of endometritis is due to the presence of bacteria in the retained products of conception, which can ascend to the uterus and cause infection.
**Why Each Wrong Option is Incorrect**
**Option A:** **Thromboembolic events** are not directly related to the clinical presentation of IUFD and retained products of conception. While thromboembolic events can occur in pregnancy, they are not a specific risk associated with this condition.
**Option B:** **Preterm labor** may be a risk in patients who experience IUFD, but it is not the most direct risk associated with retained products of conception. Preterm labor can occur in response to infection or inflammation, but it is not a specific consequence of retained products of conception.
**Option C:** **Molar pregnancy** is a separate condition that occurs when a non-viable fertilized egg implants in the uterus and grows abnormally. While a molar pregnancy can occur in the same patient who experiences IUFD, it is not a direct consequence of retained products of conception.
**Clinical Pearl / High-Yield Fact**
It is essential to perform a thorough ultrasound evaluation in patients who experience IUFD to assess for retained products of conception. If retained products of conception are suspected, a dilation and curettage (D&C) or other surgical intervention may be necessary to prevent complications such as endometritis.
**Correct Answer: D.**