The Reproductive System and Its Disorders
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss in Understanding Medical Terms, 2020
The process of giving birth is called parturition. This includes labor, which is divided into four stages, and delivery, the passage of the fetus and placenta from the genital canal into the external world. Terms associated with the birth process refer to presentation of the fetus (breech, vertex, transverse, face, cephalic, depending on which fetal structure faces the cervix) or to procedures involved (episiotomy, hysterotomy, Cesarean section). Immediately after delivery of the fetus, the secundines or "afterbirth," which includes the placenta and attached umbilical cord, are expelled as the final stage of labor. Lochia refers to the discharge of mucus, blood, and tissue debris that continues for a period of time following childbirth.
The puerperium
Louise C Kenny, Jenny E Myers in Obstetrics, 2017
Lochia is the blood-stained uterine discharge that is comprised of blood and necrotic decidua. Only the superficial layer of decidua becomes necrotic and is sloughed off. The basal layer adjacent to the myometrium is involved in the regeneration of new endometrium and this regeneration is complete by the third week. During the first few days after delivery, the lochia is red (lochia rubra); this gradually changes to pink as the endometrium is formed, serous by the second week (lochia serosa) and then ultimately a scanty yellow-white discharge (lochia alba) that lasts for about 1 month. Persistent red lochia suggests delayed involution that is usually associated with infection or a retained piece of placental tissue (see Secondary postpartum haemorrhage and Puerpural sepsis below).
Characterization and treatment of lochia
Miranda A. Farage, Howard I. Maibach in The Vulva, 2017
Lochia or puerperal loss refers to the vaginal discharge that occurs during the postpartum period. The term “lochia” originates from a Greek word that means “relating to childbirth.” The placental implantation site in the uterus does not scar, otherwise the region would not be able to hold any future pregnancies. After the placenta comes out, the uterus undergoes a process called “involution,” or shrinking. Involution is required to reduce the surface area of the uterus that can otherwise bleed since it becomes rich in blood vessels during pregnancy. During involution, the bed of the uterus is separated and falls away as part of the lochia. The tissue underneath heals and gets pushed away, similar to a scab falling off. In this way, the number of babies a woman can have is not limited by the previous placental implantations. The average duration of lochia, from the available published studies, is expected to be 24–36 days. However, lochial flow beyond 6 weeks is not unusual. The reason for this inconsistency could be that most of the studies terminated observation before the actual cessation of bleeding.
Leptrotrichia Amnionii, an emerging pathogen of postpartum endometritis
Published in Acta Clinica Belgica, 2018
Tine Masschaele, Sophia Steyaert, Ronny Goethals
Postpartum endometritis is a common cause of postpartum febrile morbidity. The United Joint Commission on Maternal Welfare defines postpartum febrile morbidity as an oral temperature of ≥38.0 °C on any 2 of the first 10 days postpartum, exclusive of the first 24 h [1]. The first 24 h are excluded because low grade fever during this period is common and often resolves spontaneously, especially after vaginal birth [2]. Postpartum fever, tachycardia, midline lower abdominal pain and uterine tenderness are the key clinical findings. Purulent lochia, chills, headache, malaise, and/or anorexia are additional findings occasionally observed [3]. Differential diagnosis should be made with episiotomy incision infection, mastitis, pyelonephritis, appendicitis, viral syndrome. Usual etiologies for postpartum endometritis include Enterobacteriaceae, Streptococcus pyogenes, Streptococcus agalactiae, mixed anaerobic genera, Mycoplasma genitalium and Chlamydia trachomatis.
Bowel on the bowl: a case report of spontaneous post-partum vaginal evisceration of small bowel
Published in Journal of Obstetrics and Gynaecology, 2018
Joanne Hui Yee Lim, Jessica Hui Cheah Lim, Grace Hui Chin Lim, Bryan Lim, Maha Alkatib
On day 2 following delivery, the patient activated the emergency buzzer after finding a mass protruding between her legs whilst opening her bowels. She was sitting on the toilet bowl distressed and holding onto prolapsed loops of bowel with tissue paper. Vaginal examination revealed approximately 40 cm of erythematous small bowel without vascular compromise. A large sterile gauze swab soaked with warmed normal saline was used to wrap around the bowel loops. Intravenous fluids and broad-spectrum antibiotics (cefuroxime 1.5 g and metronidazole 500 mg) were given pre-operatively. She was anaesthetised by rapid sequence induction and placed in the lithotomy position. Attempts were made to reduce the small bowel loops vaginally but this approach was unsuccessful due to a lack of adequate access because the tear was high in the posterior vaginal wall. Decision was made to proceed with laparotomy. She was placed in Trendelenburg position and a midline laparotomy was performed. The small bowel loops which eviscerated was noted to be about 1 m away from the ileocaecal valve. Carefully, the eviscerated bowel was gently replaced into the abdomen through the vaginal defect. The bowel was inspected thoroughly through its entire length to exclude any damage. Apart from looking slightly congested, there was a small amount of tissue paper adhering to some parts of the bowel. Lugol’s iodine solution was used to remove the tissue paper particles from the bowel. A 4 cm defect was noted in the Pouch of Douglas and this was repaired using absorbable 2–0 vicryl suture. Peritoneal lavage using 1 L of warmed normal saline was done to reduce risk of infection. Her intra-operative Haemoglobin was 80 g/L and she was given 2 units of blood transfusion. The broad-spectrum antibiotics were continued for a total of five days. When further explored, the patient admitted that her lochia had been heavy after the delivery but she thought this was normal after childbirth.
Low-intensity ultrasound promotes uterine involution after cesarean section: the first multicenter, randomized, controlled clinical trial
Published in International Journal of Hyperthermia, 2022
Yi Qin, Xiaobo Zhao, Xiaojing Dong, Juntao Liu, Longqiong Wang, Xiaohua Wu, Bin Peng, Chengzhi Li
On the 7, 14, 21, 28, and 35 days after delivery, we followed up by telephone to inquire and record the patients' lochia condition (lochia color, lochia amount) and the duration of lochia. In case of discomforts such as abdominal pain, bloody lochia greater than menstrual flow or odorous discharge, the patients received prompt treatment. On the 42 day after delivery, patients returned to the hospital to evaluate the uterine involution.
Related Knowledge Centers
- Childbirth
- Escherichia Coli
- Mucus
- Blood
- Streptococcus
- Uterus
- Vaginal Discharge
- Obstetrics
- Postpartum Period
- Postpartum Confinement