Lochia Types

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Lochia Defination:

Lochia is the vaginal discharge for the first fortnight (14 days) during puerperium, which originates from the uterine body, cervix, and vagina.
The order of lochia is peculiar offensive fishy smell. And its reaction is alkaline tending to become acid towards the end.

 

Lochia Types

Based on the color varation of lochia discharge, lochia are of 3 types.

1. Lochia rubra
2. Lochia serosa
3. Lochia alba

Compostion of different types of lochia

A. Lochia rubra (Red):

Lochia rubra is the 1st lochia discharge lasting for the first 1-4 days after deliavry and is characterized by bright red bleeding similar to a heavy menstrual period. It conatins large amount of blood, so its color is red. Lochia rubra is mainly composed of blood, shreds of fetal membranes & decidua of maternal, vernix caseosa, and meconium.

B. Lochia serosa (Yellowish/Pink/Pale brownish)

After the lochia rubra, the the color of lochia discharge gradually changes into yellowish or pinkish or brownish in color and has a thinner consistency compared to the initial stage is known as Lochia serosa. Lochia serosa usually last for 5th to 9th day after childbirth. Lochia serosa primarily consists of WBC, wound exudate, cervical mucus, few RBCs & microorganisms (anaerobic streptococci and staphylococci). Unless there is presence of signs of sepsis, presence of bacteria is not pathognomonic. 

C. Lochia alba (White)

The pale whitish vaginal discharge that usually start to appears from 10th day lasting up to 15th day after childbirth is called Lochia alba. It is the last types of lochia discharge, that we seems normally. Lochia alba is compsed of plenty of decidual cells, epithelial cells, leucocytes, mucus, cholesterol, fat, and microorganism.

 

Normal duration of lochia discharge:

Normally, lochia discharge last for 14 days on avergae, but it may extend up to 3 weeks in some cases. 

1. Lochia rubra lasts for 4 days (1st - 4th days after childbirth)
2. Lochia serosa lasts for 5 days (5th - 9th days after childbirth)
3. Lochia alba lasts for 5 days (10th - 14th days after childbirth)

Lochia rubra may persist for a longer duration, especially in women who get up from bed for the first time in the later period.

The average amount of lochia discharge for the first 5-6 days, is around 250ml.

 

Lochia discharge after Cesarean section

After a cesarean section (C-section) birth, the process of lochia is similar to that after a vaginal delivery, but the duration and amount of bleeding may vary. following we can expect lochia after a C- section.

• Initial bleeding in the first few days after the c-section,  lochia rubra which is bright red and heavier in flow. The bleeding is heavier immediately after the surgery due to the removal of the placenta and the surgical process.

• After a few days, the lochia rubra changes from bright red to pinkish-brown color and becomes lighter in flow which is known as lochia serosa. The duration of this stage can vary but generally lasts for about 1 to 2 weeks.

• Over time, the discharge will gradually change to a yellowish-white color and become less in volume which  is referred to as lochia alba. Lochia alba can persists for several weeks, up to six weeks, as the uterus continues to heal.

 

Clinical importance of Lochia

Daily inspection of lochial discharge should be made based on its order, color, amount & duration which provide information about puerperium state. 

1. Malodorous smell of lochia signifies there may be the presence of infection.
2. Scanty or absent lochia signifies there may be an infection or sociometry or especially following premature labor.
3. Excessive lochia may indicate infection.
4. The red color of lochia that is lochia rubra beyond its period indicates sub-involution or retained bits of conceptus.
5. Duration of lochia more than 3 weeks indicates local genital lesion.

 

Lochia and menstruation (Period) are two different types of vaginal bleeding that occur in different circumstances.

The difference between lochia & menstruation are given below.

Lochia:

• Timing: Lochia occurs after childbirth, regardless of whether it was a vaginal birth or a C-section. It starts within a few hours after delivery and can last for several weeks usually 2 weeks.

• Cause: Lochia is the result of the shedding of the uterine lining that supported the pregnancy. It includes blood, mucus, and tissue from the healing uterus.

• Characteristics: Initially, Lochia is bright red (Lochia rubra) and gradually changes to a pinkish-brown color (Lochia serosa) and then a yellowish-white discharge (Lochia alba).

• Flow: Lochia bleeding can be heavier than a normal period, especially in the first few days after childbirth. The flow gradually decreases over time and usually last for first 14 days after childbirth.

• Menstrual Cycle: Lochia occurs independently of the menstrual cycle.

 Menstruation (Period):

• Timing: Menstruation occurs in women of reproductive age who are not pregnant. It is part of the menstrual cycle, which usually occurs at intervals of 28 days (21-35 days).

• Cause: Menstruation is the shedding of the uterine lining through the vagina which occurs when the released egg is not fertilized during ovulation.

• Characteristics: Menstrual blood is typically bright to dark red, and may contain small blood clots. The duration and flow can vary for each individual, usually lasting around 3 to 7 days.

• Flow: The flow of menstrual bleeding can vary from light to heavy(average =35ml) and last for 4-5 days.

• Menstrual Cycle: Menstruation is part of the menstrual cycle.

It is important to note that lochia and menstruation are two different processes that serve different purposes.

Postpartum Care:

Proper hygiene during the postpartum period is essential. It is important to change sanitary pads frequently, especially in the first few days when the flow is heaviest. Avoid using tampons, as they can increase the risk of infection. Additionally, gentle cleansing of the perineal area with warm water is recommended.

Assessment of Lochia discharge:

Assessing postpartum lochia is important in monitoring a woman's recovery during puerperium irrespective of normal vaginal delivery or cesarean section. Healthcare providers use various parameters to assess the characteristics of lochia, which can provide valuable information about the healing process. we use the following parameters for assessing lochia:

1. Amount:

The healthcare provider will assess the volume of lochia,  whether it is light, moderate, or heavy. This is typically done by asking the woman how frequently she needs to change her sanitary pad. Heavy bleeding that requires frequent pad changes may indicate excessive blood loss and few pad changes indicate scanty lochia which also indicates infection.

2. Color:

The color of lochia changes over time. at first, it is bright red (lochia rubra) for the first four days, then changes to a pinkish or brownish color (lochia serosa) from 5th to 9th day and eventually becomes creamy or yellowish-white (lochia alba) from the 10th to 15th day. Any persistent bright red bleeding requires further evaluation.

3. Lochia smell: 

Lochia typically has a distinct odor, similar to the smell of menstrual blood usually a fishy odor.

4. Consistency:

The consistency of lochia can vary. Initially, it may be heavier with more clots, but over time it becomes thinner and more watery. The presence of large blood clots or prolonged passage of clots may require medical attention.

5. Duration:

The duration of lochia is also assessed. While it typically lasts up to 2 weeks but can extend up to 3 weeks or the length can vary. Prolonged or persistent bleeding beyond the expected timeframe should be evaluated.

During postpartum care, healthcare providers will regularly monitor these parameters to ensure that the lochia is progressing appropriately. If there are any concerns or deviations from the expected pattern, further investigation may be needed to rule out complications such as infection or postpartum hemorrhage.



Lochia, or postpartum discharge, can also occur in dogs after they give birth. Some important points about lochia in dogs:

Timing and duration: Dogs also pass lochia after giving birth similar to humans. The discharge usually begins within 24 to 48 hours after delivery and can last for up to four weeks but the duration can vary from dog to dog.

Characteristics: Lochia in dogs is a mixture of blood, tissue, and fluids that are discharged from the reproductive tract. at first, the discharge is usually red and may contain blood clots later as time passes, it changes to a pinkish-brown color and eventually becomes a yellowish-white or clear fluid.

Amount of discharge: The amount of lochia discharge in dogs can vary as some dogs may have a relatively light discharge, while others may have a heavy flow. It's important to monitor the discharge and look for any signs of excessive bleeding or abnormalities.

Postpartum care: During the postpartum period, it's essential to provide proper care to the mother dog which includes keeping the whelping area clean, providing a comfortable and quiet environment, ensuring the mother has access to fresh water and a balanced diet, and monitoring the lochia discharge for any concerning change.