Obstetrics & Gynecology>>>>>The Puerperium, Lactation, and Immediate Care of the Newborn
Question 33#

A 34-year-old G1P1 comes to see you 6 weeks after an uncomplicated vaginal delivery for a routine postpartum examination. She reports no problems, and has been breastfeeding her newborn without any difficulties since leaving the hospital. During the bimanual examination, you note that her uterus is irregular, firm, nontender, and about a 15-week size.

Which of the following is the most likely etiology for this enlarged uterus?

A) Subinvolution of the uterus
B) The uterus is appropriate size for 6 weeks’ postpartum
C) Fibroid uterus
D) Adenomyosis
E) Endometritis

Correct Answer is C

Comment:

The uterus achieves its previous nonpregnant size by about 4 weeks’ postpartum. Subinvolution (cessation of the normal involution) of the uterus can occur in cases of retained placenta or uterine infection. In such cases, the uterus is larger and softer than it should be on bimanual examination. In addition, the patient usually experiences prolonged discharge and excessive uterine bleeding. With endometritis, the patient will also have a tender uterus on examination, and will complain of fever and chills. In adenomyosis, portions of the endometrial lining grow into the myometrium, causing menorrhagia and dysmenorrhea. On physical examination, the uterus is usually tender to palpation, boggy, and symmetrically enlarged. The patient described here has a physical examination most consistent with fibroids. Uterine leiomyomas would cause the uterus to be firm, irregular, and enlarged.