Losing a pregnancy is an emotionally and physically difficult experience, and dealing with unexpected physical symptoms afterward can be confusing and alarming. The body undergoes a complex recovery process involving significant hormonal and physical changes. Understanding the difference between normal post-miscarriage discharge and discharge that signals a medical issue, particularly an infection, is paramount for recovery. This information provides clear guidance concerning post-miscarriage discharge, focusing on what causes a foul odor and how healthcare providers address it.
Understanding Expected Post-Miscarriage Discharge
Following a miscarriage, the body naturally expels the uterine lining and remaining tissue, resulting in vaginal bleeding and discharge known as lochia. This discharge is similar to the bleeding experienced after childbirth. It typically lasts between one and three weeks, though the duration varies depending on the gestational stage of the loss. Initially, lochia is bright red and heavy, often containing small blood clots.
Over time, the color gradually shifts to a lighter pink or brown, and finally to a yellowish-white spotting before stopping entirely. Lochia, even when healthy, is not completely odorless. Since the discharge is composed of blood, tissue, and mucus, it commonly has a mild, somewhat earthy, or metallic smell, similar to menstrual blood. This mild odor is a normal part of the healing process.
Common Causes of Malodorous Discharge
A distinctly foul, strong, or fishy smell signals that the recovery process has been complicated by an underlying medical condition. This malodorous discharge is often caused by an infection inside the uterus or the presence of tissue that the body has not fully expelled. The unpleasant odor is a direct result of bacterial activity in these cases.
One primary cause is endometritis, an infection of the endometrium (the lining of the uterus). It is typically caused by bacteria ascending from the vagina or cervix. The post-loss uterine environment is susceptible to bacterial colonization, leading to inflammation and the production of a foul-smelling discharge. Endometritis often presents with other symptoms, such as fever, lower abdominal pain, and general malaise.
Another significant cause for a severe odor is Retained Products of Conception (RPOC). This refers to placental or fetal tissue that remains in the uterus. If this tissue is not completely expelled, it can decompose or become infected, creating a breeding ground for bacteria and causing a strong, unpleasant smell. The decomposition of retained tissue can also be accompanied by prolonged or heavy bleeding and severe cramping.
Immediate Warning Signs and When to Seek Urgent Care
While a mild odor is expected, a foul smell combined with other symptoms must be medically evaluated immediately, as it can signal a serious infection. Several specific red flag symptoms indicate the need for urgent medical attention.
Seek emergency care if you develop a high fever, defined as 100.4°F (38°C) or higher, especially if accompanied by chills or shivering. A fever alongside a foul-smelling discharge strongly suggests a spreading infection, such as septic miscarriage or pelvic inflammatory disease (PID).
Extremely heavy or excessive bleeding is also an emergency sign that requires immediate action. This is defined as soaking more than two large sanitary pads in an hour for two consecutive hours, or passing large blood clots that are golf ball-sized or larger. Severe or worsening abdominal or pelvic pain not relieved by over-the-counter pain medication also needs prompt medical assessment. Other urgent symptoms include signs of shock, such as dizziness, lightheadedness, or fainting.
Medical Diagnosis and Treatment Options
A healthcare provider will perform a physical examination, including a pelvic exam, to assess the uterus for tenderness and the nature of the discharge. They may take a vaginal swab to test for bacterial infections, such as bacterial vaginosis (BV) or endometritis, which can cause a distinct fishy odor.
An ultrasound is often performed to visualize the uterine cavity and determine if any retained products of conception are present. Persistent levels of human chorionic gonadotropin (hCG) in the blood may also suggest that tissue remains.
If the foul odor is caused by an infection like endometritis, the standard treatment is a course of broad-spectrum antibiotics. Prompt antibiotic treatment is effective and helps prevent the infection from spreading to other pelvic organs.
If the diagnosis confirms Retained Products of Conception, the physician may recommend either medical or surgical management.
Medical Management
Medical management typically involves administering medication, such as misoprostol, to help the uterus contract and expel the remaining tissue naturally.
Surgical Management
For cases where the tissue is significant or medication is unsuccessful, a minor surgical procedure called a Dilation and Curettage (D&C) is performed. This procedure gently removes the remaining tissue from the uterine lining.
It is important to remember that avoiding douching and using sanitary pads cannot resolve an underlying infection or retained tissue, underscoring the necessity of medical intervention.