Question
A 25-year-old gravida 1 para 1 female presents with pelvic pain 5 weeks postpartum. Her pregnancy was uncomplicated, and she currently denies any complaints. She is afebrile and her vital signs are stable. A bimanual pelvic exam reveals an irregular-shaped, firm, and non-tender uterus. It is the size of a 14-week gestation uterus. Which of the following is the most likely diagnosis?
| A. |
Retained placenta
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| B. |
Adenomyosis
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| C. |
Uterine leiomyoma
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| D. |
Endometritis
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Show Answer
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Correct Answer � C
Explanation
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Ans. C
- Uterine leiomyomas can cause the uterus to be firm, irregular, and enlarged. Patients may present with low back pain, dyspareunia, pelvic pressure or pain, urinary urgency, frequent urination, or dysfunctional uterine bleeding.
- With endometritis, the patient would have a fever with a tender uterus.
- Although adenomyosis can be difficult to differentiate from fibroids, they usually result in an asymmetrical, globular-shaped uterus on the bimanual exam. This patient’s presentation shows an irregularly shaped uterus.
- Retained placental tissue would usually result in vaginal bleeding in the early postpartum period. It is unlikely that this patient’s presentation is a result of placental tissue given her primary complaint is pelvic pain.
