Abnormal postpartum bleeding: how to recognize and treat it?

 Abnormal postpartum bleeding: how to recognize and treat it?

You will have postpartum vaginal bleeding and discharge whether you give birth naturally or by Cesarean section. Lochia is the name for this. It's how your body gets rid of the additional blood and tissue that helped your baby grow in your uterus.

The first few days after your kid is delivered are when bleeding is the worst. However, if the bleeding is still severe after that, you might want to consult your doctor.

Some women find it comforting that they won't have their period throughout the pregnancy and at least the first few months after giving birth. But what is less frequently discussed is the lochia or the four to six weeks of postpartum menstruation and discharge that follow childbirth.

Lochia initially has a "bloody" appearance, which is why it's sometimes known as postpartum bleeding. Although it definitely looks to make up for the nine months without a period, lochia is made up of more than simply red blood cells and is not menstrual bleeding. Let's discuss what lochia is, what fertility charting postpartum looks like during the first four to six weeks as you wait for lochia to resolve, and when to call your doctor if your postpartum bleeding appears unusual.

What is "lochia," or postpartum bleeding, and how long does it last?

Your kid has been floating about in amniotic fluid in the womb for nine months, give or take. The endometrium, or uterine wall, has been developing a lovely thick layer of blood, placental tissue, endometrial lining, and mucus as a result of high levels of estrogen and progesterone. Therefore, whether you had your baby vaginally or by C-section, there is still a mass of tissue called lochia that needs to be cleared from the uterus after the baby is born and the placenta is delivered. But as opposed to the baby and placenta, which emerge completely and simultaneously, this leftover tissue is progressively shed over four to six weeks. 

The placental site, which can be up to 8.5 inches in diameter, is left behind after the placenta separates from the endometrial wall. That is the size of a dinner dish, to give you some context. So, at this period, a new mother not only experiences the bleed of all bleeds, but her body is also attempting to mend an open uterine lesion. This is just more justification for new mothers to do very little other than bond with their children, rest, hydrate, and feed both their infants and themselves. When new mothers exert too much effort, the amount of lochia they produce frequently rises when the placental location bleeds, which slows the healing process. 

There is frequently less lochia and faster healing when they can relax. This explains why some women who are very busy in the first few days after giving birth experience postpartum bleeding that stops and starts.

Stages of postpartum bleeding

There are 3 stages to postpartum bleeding or lochia. They are:

Initial stage: Lochia Rubra

The first four days after giving birth are when you go through the Rubra period. The uterus is still contracting to return to its former, much smaller size during the first stage, which is when cramping is most intense. Many nursing mothers have observed that almost immediately when the infant latches on, they start to feel lower abdomen cramping, similar to menstruation cramps. This is because suckling and a milk "letdown" cause an oxytocin surge.

Due to blood collecting within the vagina, many women may also experience a "gush" of blood upon getting up from a seated position. The lochia bleeding will be bright red and may contain some clots during the Rubra stage, but these clots shouldn't be large or challenging to pass. Clots are brought on by blood that pools and they often appear in the first two weeks following delivery. The general guideline is that anything bigger than a golf ball justifies calling your doctor.

Lochia Serosa, second stage

The Serosa stage, which starts when postpartum bleeding changes from bright red to pink or even brown, lasts for around ten days. The main cause of the color shift at this stage is the proportionally greater number of white blood cells than red blood cells in the lochia. The placental site is still mending at this point, but it has come a long way in a short period. Women may see what they believe to be cervical fluid at this time. It might be if they are not nursing at all. However, the discharge is more likely to be caused by the cervix's cells continuing to shed the mucus plug remnants in nursing mothers.

Stage Three: Lochia Alba

The last (and longest) stage of postpartum discharge is known as the Alba stage. It might not even appear to be bleeding at this time. Lochia, which is made up of cervical mucus, white blood cells, and epithelial tissue, will be a yellowish-whitish tint. More skin is being shed off because the placental location is healing quickly by generating new skin tissue.

All things considered, the duration of the three lochia phases is often between four and six weeks. However, it might last longer or shorter depending on the activity level and stress level of the new mother.

Warning signs for abnormal postpartum bleeding

In the following conditions visit your healthcare professional, if you experience unusual postpartum bleeding.

If the amount of postpartum bleeding doesn't appear to be decreasing daily.

If more than one menstruation pad is filled in an hour.

If bleeding stays bright red after the first three days and doesn't change to brown or pink.

If the clots exceed the size of a golf ball.

If blood clots last longer than two weeks.

If you get chills, pains, a strong headache, or a fever.

If your eyesight is fuzzy, you feel weak, faint, or unsteady.

If you suffer breastfeeding-related stomach pain that is not due to cramps.

If your vaginal discharge smells bad (lochia may smell musty, but never foul).

Any of these symptoms should be reported right away to your OB or midwife. Some of these signs might point to postpartum bleeding or infection, both of which can be fatal if left untreated. You can learn which kinds of postpartum bleeding are typical and which are not from your healthcare professional.

During this time, don't hesitate to speak up for yourself since your health and happiness are just as vital as your newborn's.

The terms "fertility awareness methods" (FAM) and "natural family planning" (NFP) in this page relate to Fertility Awareness-Based Techniques, which are evidence-based methods of cycle charting that, when acquired from a licensed teacher, can be utilized as effective forms of natural birth control.

Treatment for bleeding after giving birth

Postpartum hemorrhage can be treated in several ways. The reason and intensity of the postpartum bleeding, however, affect the therapeutic option. Among the remedies for postpartum bleeding are:

Medication: The first line of therapy for postpartum bleeding is often uterotonic medication. It aids in uterine contraction, which stops bleeding.

Uterine massage: If a medical professional observes persistent bleeding after birth, they could try massaging the uterus to halt it. As a result, the bleeding is stopped as the uterus is assisted in contracting.

Uterine balloon tamponade: This method of halting postpartum bleeding is also quite successful. To increase pressure and control the bleeding, a Bakri balloon is inflated inside the uterus.

Surgery: To identify the source of bleeding, a laparotomy is a surgical procedure that entails opening up the abdomen. It is taken into account once less drastic measures have failed. In addition to different compression stitches, the surgeon may also ligate the internal iliac, uterine, or ovarian arteries or, as a last resort, execute a hysterectomy. The uterus is surgically removed during a hysterectomy.

Transfusion of blood; To replenish blood lost during this procedure, fresh blood is intravenously infused into the body.

Stenting of the uterine artery: This procedure involves a radiologist doing specialized tests to identify the blood artery that is bleeding. To halt the bleeding, the radiologist then injects tiny particles into the vessel.

Uterine curettage: Using either physical labor or specialized instruments, the placenta's remaining fragments are extracted from the uterus using this technique.

To choose the most appropriate course of therapy for you, speak with a healthcare professional. A life-threatening condition may be abnormal postpartum hemorrhage. If you have any of these symptoms, tell your healthcare professional right away.

Avoiding any form of intense activity or exercise is crucial throughout the postpartum healing process, particularly following a postpartum hemorrhage. It is advised to obtain enough sleep.

Watch what you eat and drink as well. Consume iron-rich meals, such as:

  • Vegetables with dark-green leaves, like spinach.
  • Chickpeas, nuts, and pumpkin seeds.
  • Lentils.
  • Peas and beans
  • Seafood and red meat.

The body makes an effort to replace any blood that is lost. The body may quickly run out of iron if there is constant bleeding, making it impossible for hemoglobin to synthesize. Anemia due to iron deficiency is what this is. For this reason, it's critical to have an iron-rich diet.

Vitamin C-rich foods should also be a part of your diet since they aid in the body's absorption of iron. It is best to minimize your consumption of calcium-rich foods since they may have a short-term adverse impact on your ability to absorb iron.

To prevent constipation, include high-fiber meals like whole grains and fruits in your diet. And last, look for your emotional health and well-being. Postpartum depression is a common side effect for many women who have had postpartum hemorrhage. Talk to your doctor or a mental health professional if you have postpartum depression, or join a support group of other women who have gone through the same thing. Recovery might benefit from support on both a physical and emotional level.

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