For postpartum hemorrhage, the four Ts are Tone, Tear, Tissue, and Thrombin. Which is described as retained placental fragments?

• A. Tissue
• B. Tone
• C. Tear
• D. Thrombin

Answer: (A)

The main idea here is that tissue represents retained placental tissue. After delivery, placental fragments or a missed placental lobe can remain inside the uterus. Those fragments continue to bleed and prevent the uterus from involuting normally, so postpartum hemorrhage persists despite initial efforts to contract the uterus with uterotonic medications. This category is specifically about retained products of conception causing ongoing bleeding.

Clinically, you’d see heavy vaginal bleeding in the postpartum period with signs of incomplete placental expulsion, such as a uterus that feels enlarged or tender and ongoing lochia. Confirmation is usually with ultrasound showing placental tissue within the uterus. Management focuses on removing the remnants, typically via suction curettage or manual removal, while continuing uterotonic therapy and considering antibiotics if infection is suspected.