Lochia in the Postpartum Period
Written by : Dr.M.D.Mazumdar, MD
The discharge consists of
(1) Discharge and blood from the area on the uterine wall to which the placenta was attached during the pregnancy
(2) The sloughed off endometrium which gets considerably thickened during pregnancy.
(3) Blood and mucus from the healing cervix and
(4) Dead and necrotic tissue.
The blood in the lochia comes mainly from the large raw area left on the inner uterine wall after the placenta detaches from it. While bleeding from this area is controlled by contraction of the uterine muscles immediately after delivery, it takes about 2 weeks for this area to heal.
That is why bleeding is maximum in the fist 2-3 days after birth and then decreases over the next two weeks.
The lochia is sterile for the first 2-3 days but then becomes colonised by bacteria giving off a typical lochial smell which is normal and should not be confused with the bad odor from lochia in postpartum infection.
The quantity of lochia may be scanty after a premature delivery but more than normal after a twin pregnancy or other conditions in which the uterus becomes larger than an average-size pregnancy uterus.
Types of LochiaDepending on the color, lochia can be of three types:
- Lochia Rubra: Lochia rubra occurs in the first 3-4 days after childbirth. It is reddish in colour-hence the term 'rubra'. It is made up of mainly blood, bits of fetal membranes, decidua, meconium and cervical discharge.
- Lochia Serosa: The lochia rubra gradually changes colour to brown and then yellow over a period of about I week. It is called lochia serosa at this stage. The lochia serosa contains less red blood cells but more white blood cells, wound discharge from the placental and other sites, and mucus from the cervix.
- Lochia Alba: The Lochia alba is a whitish, turbid fluid which drains from the vagina for about another 1 - 2 weeks. It mainly consists of decidual cells, mucus, white blood cells, and epithelial cells.
Amount of LochiaThe amount of lochia will may vary from time to time. In some women, painful contraction of the uterus after delivery ('afterpains') may lead to a gush of heavy bleeding with clots which decreases spontaenously.
Sometimes getting up from a sitting down or lying down position may lead to a rush of blood - this is just drainage of the collected blood in the vagina and is not a cause for worry.
Management of Lochia
Lochia does not need any specific management. One thing which should be remembered is that the placental area as well as the sites of sloughing endometrium are raw and open during this time and bacteria can easily spread from the vagina. So, use of tampons should be avoided - sanitary pads are the best options to be used at this time.
Sex should also be avoided during this time due to the same reason - to avoid spread of bacteria.
Bathing in public pools are also best avoided until the lochia has completely stopped.
Using a Sitz bath may help to clean out the vagina and also soothe the episiotomy stitches , if any.
Abnormalities of of LochiaThe lochia may be abnormal if infection occurs at this time. Infection can be suspected when :
- The Lochia continues to remain bright red even after the first week from childbirth.
- The lochia becomes bright red again after having become paler over the previous days.
- There is abnormally heavy bleeding causing a sanitary pad to soak through within 1 hour or less or there is passage of blood clots larger than a golf ball. This is a sign of secondary postpartum hemorrhage and needs emergency treatment.
- It has an unpleasant smell.
- There is fever with chills.
- There is pain in the lower abdomen which increases over the days.
Lochia after a Cesarian SectionMany women believe that the flow of lochia is less after a cesarian section since the uterine cavity is cleaned out after the birth of the baby. This is not true. The flow of lochia is not dependent on the type of delivery - normal vaginal childbirth or C-section. The amount and duration is the same in both cases.
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