A patient at 17 weeks gestation is diagnosed as having an intrauterine fetal demise. She returns to your office 5 weeks later and has not had a miscarriage, although she has had some occasional spotting. This patient is at increased risk for
**Core Concept**
The patient is at increased risk for postpartum hemorrhage (PPH) and other complications due to retained products of conception (RPOC) after an intrauterine fetal demise (IUFD). RPOC can lead to infection, bleeding, and other complications.
**Why the Correct Answer is Right**
In this scenario, the patient has had an IUFD at 17 weeks gestation and has not had a miscarriage 5 weeks later. This suggests that the products of conception are retained within the uterus, which can lead to PPH and other complications. The patient's occasional spotting may be a sign of subacute hemorrhage or infection. Retained products of conception can cause uterine irritation, leading to increased risk of PPH, infection, and other complications.
**Why Each Wrong Option is Incorrect**
* **Option A:** This option is not directly related to the scenario described. While it is true that placental abruption can cause PPH, it is not the most likely complication in this case.
* **Option B:** Infection is a possible complication, but it is not the most direct consequence of retained products of conception. While infection can occur, PPH is a more immediate concern.
* **Option D:** This option is not directly related to the scenario described. While it is true that uterine atony can cause PPH, it is not the most likely complication in this case.
**Clinical Pearl / High-Yield Fact**
When managing patients with IUFD, it is essential to monitor for signs of retained products of conception, such as persistent spotting or bleeding, and to perform a timely dilation and curettage (D&C) to prevent complications.
**Correct Answer:** B. Infection is a possible complication, but PPH is a more immediate concern.