SYMPTOMS

What is Postpartum Lochia?

After childbirth, as the decidua (the thickened endometrium during pregnancy) sheds, a mixture of blood, necrotic decidua, and other tissues is discharged through the vagina. This is called postpartum lochia, a normal physiological process as the uterus gradually returns to its pre-pregnancy state.

Uterine involution refers to the process by which the enlarged uterus gradually shrinks back to its pre-pregnancy size, which typically takes about 6 weeks.

What Does Postpartum Lochia Look Like?

Depending on color, consistency, and timing, lochia may have a bloody smell but should not be foul. It is divided into three types:

• Lochia Rubra: Contains a large amount of blood, is bright red in color, and is heavy in volume, sometimes with small clots. It usually only occurs in the first 3 days postpartum before transitioning to lochia serosa.
• Lochia Serosa: Named for its high serous fluid content, it is pale red. Microscopically, it contains necrotic decidual tissue, uterine cavity exudate, cervical mucus, a small number of red and white blood cells, and bacteria. Lochia serosa typically lasts from days 4 to 14 before gradually decreasing and turning into lochia alba.
• Lochia Alba: Named for its high white blood cell content and white appearance, it is thick and sticky. Microscopically, it contains a large number of white blood cells, necrotic decidual tissue, epithelial cells, and bacteria. Lochia alba usually lasts about 3 weeks before clearing.

Why Is There Blood in Postpartum Lochia?

After childbirth and placental detachment, the uterine wall has many small severed blood vessels. In the first 3–4 days postpartum, blood flows out with the shedding decidua, resulting in lochia rubra. As these blood vessels heal, bleeding gradually stops, and lochia rubra transitions to lochia serosa.

What Is the Serous Fluid in Postpartum Lochia?

Lochia serosa appears after lochia rubra. The serous fluid mainly consists of mucus secreted by the uterine cavity and increased vaginal discharge, with less blood, making it lighter in color than lochia rubra.

Does Postpartum Lochia Have an Odor?

Early lochia has a bloody smell due to the high blood content, but normal lochia should not have a foul odor.

Why Does Abdominal Pain Occur During Postpartum Lochia?

In the first 3–4 days postpartum, uterine contractions may cause intermittent abdominal pain. Additionally, breastfeeding stimulates the pituitary gland to release oxytocin, which promotes uterine involution, making the pain more noticeable during nursing. This is a normal physiological phenomenon.

If abdominal pain persists beyond 3 days, it may indicate infection or other issues, and medical advice should be sought promptly.

How Long Does Postpartum Lochia Last?

From childbirth until lochia completely clears, it typically takes about 4–6 weeks, with a total volume of approximately 250–500 ml. Normally, the uterus returns to its pre-pregnancy state within these 6 weeks.

TREATMENT

How should postpartum lochia be cared for? Is sexual activity allowed?

Since the uterine wound has not yet healed and is prone to infection, the perineum should be cleaned with water after each urination or bowel movement. Avoid baths and sexual activity, and maintain local cleanliness until the end of the puerperium (6 weeks postpartum).

How to prevent lochia from affecting perineal incision healing?

Episiotomy incisions are often located on the left side, so lying on the right side can help lochia flow away from the incision. Keep the area clean and dry, and it usually won’t affect healing.

Is medication needed to prevent postpartum lochia?

Medication is generally not required for prevention.

If poor uterine involution occurs, consult a doctor about using medications (such as oxytocin) to aid recovery.

DIAGNOSIS

How to Tell if Postpartum Lochia is Normal?

During the lochia stage, sanitary pads are typically used. Pay attention to the amount, color, and odor of the lochia on the pad. Normally, there may be a bloody smell but no foul odor.

How to Differentiate Between Postpartum Lochia and the First Postpartum Period?

During lochia discharge, the uterine lining has not fully healed, and menstruation usually does not occur. Normal lochia contains more blood, especially within the first 3–4 days postpartum. Therefore, timing can generally help distinguish between the two. If bleeding resembling a period occurs within 6 weeks, it is considered abnormal bleeding and requires medical consultation.

If bloody discharge appears after 42 days postpartum, there are three possibilities: abnormal lochia (not fully expelled), abnormal bleeding, or the return of menstruation. The first two often come with other discomforts, such as abdominal pain, foul-smelling discharge, or heavier-than-normal menstrual flow. If unsure, consult a doctor promptly.

Is Postpartum Lochia Related to Cesarean Delivery?

Generally, there is no direct impact. However, compared to vaginal delivery, cesarean sections carry a higher risk of postpartum uterine infections due to trauma and bleeding. If an infection occurs, abnormal lochia may result.

What to Do if Postpartum Lochia Persists or Is Abnormal?

Seek medical attention immediately if any of the following occurs:

• Prolonged duration: Bloody lochia persists beyond 6 weeks.
• Abnormal characteristics: Lochia appears cloudy, foul-smelling, or involves heavy bleeding.
• Recurrence of discharge after lochia has stopped, accompanied by abdominal pain or fever.

How Is Persistent Postpartum Lochia Treated?

If lochia persists, seek medical care promptly. Doctors will provide targeted treatment based on the cause:

• For poor uterine involution: Medications like oxytocin may be given to strengthen uterine contractions.
• For retained placental or membrane tissue: Surgical dilation and curettage may be necessary.
• For infections: Antibiotics will be administered promptly.

What Are the Serious Consequences of Untreated Persistent Postpartum Lochia?

Persistent lochia is often caused by poor endometrial recovery or infection. Without timely treatment, the infection may spread to the entire pelvic cavity, leading to pelvic inflammatory disease or even systemic sepsis, with severe consequences. Therefore, prompt intervention is crucial.

Does Abnormal Postpartum Lochia Affect Future Pregnancy and Delivery?

With active and effective treatment, the uterine lining can generally heal, and uterine involution will return to normal, posing no impact on future pregnancies or deliveries.

POTENTIAL DISEASES

What is prolonged postpartum lochia?

If lochia persists for more than 6 weeks after delivery, it is called prolonged postpartum lochia.

What causes recurrent prolonged postpartum lochia?

If the uterus does not recover properly, or if there are retained placental or membrane tissues, or infection in the uterine cavity, the duration of lochia will be prolonged, with increased volume, foul odor, and delayed cessation.

What are the causes of prolonged postpartum lochia?

Subinvolution of the uterus is the primary cause of prolonged lochia, meaning the uterus fails to return to its pre-pregnancy state due to various factors. Any condition that affects uterine contraction and involution can lead to prolonged lochia:

• Retained placenta or membranes during delivery;
• Pelvic infection;
• Uterine fibroids;
• Excessive retroversion or lateral flexion of the uterus, hindering lochia drainage;
• Multiple pregnancies causing increased uterine muscle fibers, affecting contractions;
• Postpartum urinary retention or overdistended bladder impairing uterine contractions.