Lochia

For the genus of moth, see Lochia (moth). For the plant genus, see Aristolochia.

In the field of obstetrics, lochia is the vaginal discharge after giving birth (puerperium) containing blood, mucus, and uterine tissue.[1] Lochia discharge typically continues for 4 to 6 weeks after childbirth,[2] which is known as the postpartum period.

It is sterile for the first 2 to 3 days, but not so by the third or fourth day, as the uterus begins to be colonized by vaginal commensals such as non-hemolytic streptococci and E. coli.[3]

Stages

It progresses through three stages:[4]

  1. Lochia rubra (or cruenta) is the first discharge, Composed of blood, shreds of fetal membranes, decidua, vernix caseosa, lanugo and membranes. It is red in color because of the large amount of blood it contains. It typically lasts no longer than 3 to 5 days after birth.
  2. Lochia serosa is the term for lochia that has thinned and turned brownish or pink in color. It contains serous exudate, erythrocytes, leukocytes, cervical mucus and microorganisms. This stage continues until around the tenth day after delivery. Lochia serosa which persists to some weeks after birth can indicate late postpartum hemorrhaging, and should be reported to a physician.
  3. Lochia alba (or purulenta) is the name for lochia once it has turned whitish or yellowish-white. It typically lasts from the second through the third to sixth weeks after delivery. It contains fewer red blood cells and is mainly made up of leukocytes, epithelial cells, cholesterol, fat, mucus and microorganisms. Continuation beyond a few weeks can indicate a genital lesion, which should be reported to a physician.

Note: Ambulant patients < 2 weeks, Moribund Patients > 2 weeks, Preterm Delivery < 2 weeks, Twin Delivery > 2 weeks.

Complications

In general, lochia has an odor similar to that of normal menstrual fluid. Any offensive odor or change to a greenish color indicates contamination by organisms such as chlamydia or saprophytic.

Lochia that is retained within the uterus is known as lochiostasis[5] or lochioschesis, and can result in lochiometra[6] (distention of the uterus - pushing it out of shape). Lochiorrhea describes an excessive flow of lochia and can indicate infection.

References

  1. ↑ Murkoff, Heidi; Eisenberg, Arlene; Hathaway, Sandee (2002). What To Expect When You're Expecting (3rd ed.). New York: Workman. p. 383. ISBN 0-7611-2132-3. This discharge of leftover blood, muscus, and tissue from your uterus, known as lochia, is normally as heavy as (and sometimes even heavier than) a menstrual period for the first three to ten postpartum days.
  2. ↑ Oppenheimer, LW; Sherriff, EA; Goodman, JD; Shah, D; James, CE (July 1986). "The duration of lochia". Br J Obstet Gynaecol 93 (7): 754–757. PMID 3755355.
  3. ↑ Hanretty, Kevin P. (2009). Obstetrics Illustrated. Illustrated by Ian Ramsden and Robin Callander (7th ed.). Churchill-Livingston. p. 337. ISBN 978-0-7020-3066-6. Retrieved 13 November 2013.
  4. ↑ Sherman, D.; Lurie, S.; Frenkel, E.; Kurzweil, Y.; Bukovsky, I.; Arieli, S. (1999). "Characteristics of normal lochia". Am J Perinatol 16 (8): 399–402. doi:10.1055/s-1999-6818. PMID 10772198.
  5. ↑ "lochioschesis - definition of lochioschesis in the Medical dictionary - by the Free Online Medical Dictionary, Thesaurus and Encyclopedia.".
  6. ↑ "lochiometra - definition of lochiometra at the Free Dictionary by Farlex".
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