A patient at 17 weeks gestation is diagnosed as having an intrauterine fetal demise on USG. She comes back to the OPD only after 5 weeks of the scan and has not expelled the fetus yet. She has had some occasional spotting. This patient is at increased risk for which of the following ?

**Core Concept**
Intrauterine fetal demise (IUFD) at 17 weeks gestation, coupled with delayed fetal expulsion and occasional spotting, increases the risk of infection, particularly endometritis and sepsis, due to retained products of conception (RPOC). The patient's immune system is compromised, making her susceptible to bacterial invasion.

**Why the Correct Answer is Right**
The patient's body is attempting to expel the non-viable fetus, but the process has been delayed, creating an environment conducive to bacterial growth. The retained products of conception (RPOC) can become a source of infection, leading to endometritis and sepsis. The patient's occasional spotting may be a sign of the body's attempt to expel the fetus, but it also increases the risk of bacterial translocation.

**Why Each Wrong Option is Incorrect**
* **Option A:** Placenta accreta is not directly related to IUFD or delayed fetal expulsion.
* **Option B:** Intrauterine growth restriction (IUGR) is a risk factor for IUFD, but it is not the most likely complication in this scenario.
* **Option D:** Postpartum hemorrhage (PPH) is a risk factor for patients who have recently given birth, not those with IUFD.

**Clinical Pearl / High-Yield Fact**
A patient with intrauterine fetal demise and delayed fetal expulsion is at increased risk for endometritis and sepsis due to retained products of conception. Prompt management with antibiotics and consideration of dilation and curettage (D&C) is crucial to prevent infection.

**Correct Answer:** C. Endometritis

✓ Correct Answer: C. Consumptive coagulopathy with hypofibrinogenemia