Lochia

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

In the field of obstetrics, lochia is the vaginal discharge after giving birth, containing blood, mucus, and uterine tissue.^[1] Lochia discharge typically continues for four to eight weeks after childbirth,^[2] a time known as the postpartum period or puerperium. A 2016 review ties this "lochial period" to worldwide customs of postpartum confinement, a time for the new mother and baby to bond.^[3]

Lochia is sterile for the first two 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.^[4]

Stages

It progresses through three stages:^[5]

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 lasts 1 to 4 days after birth, before easing to light "spotting".^[6]
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.

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 staph saprophyticus.^[7]

Lochia that is retained within the uterus is known as lochiostasis^[8] or lochioschesis, and can result in lochiometra^[9] (distention of the uterus - pushing it out of shape). Lochiorrhea describes an excessive flow of lochia and can indicate infection.^[10]

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. doi:10.1111/j.1471-0528.1986.tb08063.x. PMID 3755355. S2CID 221487083.
3. Sharma S, van Teijlingen E, Hundley V, Angell C, Simkhada P. Dirty and 40 days in the wilderness: Eliciting childbirth and postnatal cultural practices and beliefs in Nepal. BMC Pregnancy Childbirth. 2016;16(1):147. Published July 5 2016. doi:10.1186/s12884-016-0938-4
4. 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.
5. 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.
6. "Postpartum Bleeding: What To Expect and How To Manage It". Yoppie.com.
7. "What Is Lochia". Elite Doula.
8. "lochioschesis - definition of lochioschesis in the Medical dictionary - by the Free Online Medical Dictionary, Thesaurus and Encyclopedia".
9. "lochiometra - definition of lochiometra at the Free Dictionary by Farlex".
10. Shevtsova, Maria. "Postpartum Bleeding – The Healing Wound". Mother How. Also, a profuse lochia discharge three weeks after childbirth can be a sing of lochiorrhea. Lochiorrhea may indicate an infectious disease in a woman or a sign of disturbed blood coagulation.