Abnormal Postpartum Bleeding: How to Recognise and Manage It
Postpartum bleeding—also known as lochia—is a normal process as the uterus sheds its lining after childbirth. However, when bleeding is unusually heavy, prolonged, or accompanied by other warning signs, it may indicate a serious condition called postpartum haemorrhage (PPH).
This article explains the common causes, symptoms, and management of abnormal postpartum bleeding, and when to seek medical attention.
What Is Normal Postpartum Bleeding (Lochia)?
Lochia is vaginal discharge that occurs in stages after birth, typically lasting 4 to 6 weeks. It starts bright red (lochia rubra), becomes pinkish‑brown (lochia serosa), then turns yellowish‑white (lochia alba) before subsiding entirely :contentReference[oaicite:2]{index=2}.
Small clots are common early on—but clots larger than a golf ball, very heavy bleeding, or foul-smelling discharge should prompt medical advice :contentReference[oaicite:3]{index=3}.
What Counts as Abnormal Bleeding?
Bleeding becomes concerning if:
- You soak through more than one thick pad per hour
- Clots are larger than a golf ball or prune-sized
- You feel faint, dizzy, or excessively fatigued
- Your pulse is high or blood pressure drops
These may signal postpartum haemorrhage—which can occur immediately or up to 12 weeks after birth :contentReference[oaicite:4]{index=4}.
Leading Causes: The “Four Ts”
Abnormal postpartum bleeding is typically caused by the four Ts:
- Tone (Uterine Atony): When the uterus fails to contract effectively, blood flow remains uncompressed. This is the most common cause, responsible for ∼70–80 % of cases :contentReference[oaicite:5]{index=5}.
- Trauma: Tears or lacerations to the cervix, vagina or uterus during birth can bleed persistently even if the uterus is well contracted :contentReference[oaicite:6]{index=6}.
- Tissue: Retained placental fragments (e.g. placenta accreta or retained placenta) prevent full contraction and clot formation, increasing bleeding risk :contentReference[oaicite:7]{index=7}.
- Thrombin (Coagulopathy): Underlying bleeding disorders or clotting problems can intensify bleeding even with normal uterine contractions :contentReference[oaicite:8]{index=8}.
Less Common—but Serious—Causes
Rare complications such as uterine inversion or uterine rupture may present with severe bleeding and shock-like symptoms. Uterine inversion involves the uterus turning inside out and occurs in approximately 1 in 2,000–10,000 deliveries, with a high risk of death unless treated immediately :contentReference[oaicite:9]{index=9}.
Recognising Warning Signs
Be alert for:
- Uncontrolled vaginal bleeding
- Weakness, lightheadedness or rapid heart rate
- Uterus feeling soft or boggy on touch (medical staff assessment)
- Severe pain or sense of a mass in the vagina (possible inversion)
If bleeding is sudden or accompanied by fainting, headache, fever or chills, seek immediate medical care :contentReference[oaicite:10]{index=10}.
Medical Management and Treatments
Healthcare providers will assess the cause, measure blood loss, check vital signs and perform physical examination.
Treatment may include:
- Bimanual uterine massage to stimulate contractions
- Uterotonic medications such as oxytocin, misoprostol, ergometrine or prostaglandins :contentReference[oaicite:11]{index=11}
- Removal of retained tissue or manual exploration
- Surgical repair of lacerations or genital tract trauma
- Tamponade with devices like a Bakri balloon if bleeding continues :contentReference[oaicite:12]{index=12}
- Advanced interventions: compression sutures, arterial ligation, or hysterectomy in severe cases :contentReference[oaicite:13]{index=13}
- Blood transfusion and IV fluids to support circulation
- Antibiotics if infection or uterine inversion suspected
Preventive Measures at Birth
Active management of the third stage of labour helps reduce risk. This may include uterotonic use, controlled cord traction, and uterine massage immediately after birth. Early breastfeeding also aids uterine contraction via oxytocin release :contentReference[oaicite:14]{index=14}.
Home Care During Lochia
Most postpartum bleeding resolves naturally, but safe at-home management includes:
- Using sanitary maxi pads or disposable underwear—no tampons or internal products for at least 6 weeks
- Changing pads regularly and noting flow and clot size
- Resting and avoiding strenuous activity in early weeks
- Monitoring for signs of infection: fever, chills, foul smell
This guidance helps reduce infection and detect abnormal bleeding early :contentReference[oaicite:15]{index=15}.
When to Seek Help Immediately
Contact your healthcare provider—or go to the emergency department—if you experience:
- Heavy bleeding soaking pads every hour
- Large clots (prune or golf‑ball size)
- Dizziness, faintness, palpitations or fast heart rate
- Persistent fever, offensive smell or severe pain
Final Thoughts
While postpartum bleeding (lochia) is a natural process, recognising the difference between normal and abnormal bleeding is essential for your safety. Most abnormal cases stem from uterine atony, retained tissue, trauma or clotting issues.
Early intervention—through uterine massage, medication, or surgical procedures—often prevents serious outcomes. If unsure, it’s always safest to consult a healthcare provider promptly.