The postpartum period involves significant physical recovery, and understanding the difference between normal bodily changes and medical emergencies is important for new mothers. Bleeding and the passage of blood clots are expected parts of the healing process as the uterus returns to its pre-pregnancy size. While most symptoms are benign, certain signs, particularly related to the size of clots or accompanying systemic issues, require immediate medical attention. Knowing the specific indicators of conditions like a retained placenta or venous thromboembolism allows for timely intervention and safety.
The Baseline: Normal Postpartum Bleeding and Clots
The vaginal discharge experienced after childbirth is known as lochia, which consists of blood, tissue, and mucus from the uterine lining. Immediately following delivery, the flow, called lochia rubra, is typically heaviest and bright red, often resembling a very heavy menstrual period. This phase generally lasts for the first three to four days before the discharge begins to lighten in color and volume. Small blood clots often form as the blood pools and then exits the uterus, especially after periods of rest or upon standing.
Clots that are considered normal during the first week are typically small, no larger than a quarter or a grape. The flow should gradually lessen over the first week, becoming pinkish or brownish (lochia serosa) and then a yellowish-white discharge (lochia alba) over the next few weeks. The entire process can last up to six weeks, but the presence of any clots should become increasingly rare and smaller after the first few days. A temporary increase in flow or a small gush of blood can sometimes occur, especially with physical activity or during breastfeeding, which stimulates uterine contractions.
Retained Placenta: Symptoms and Urgency
A retained placenta occurs when part of the placenta or its membranes remains inside the uterus after the baby has been delivered. The placenta is normally expelled within 30 to 60 minutes after birth, and its incomplete removal prevents the uterus from properly contracting. This failure to contract places the mother at immediate risk for severe postpartum hemorrhage and infection.
Symptoms of retained fragments often appear in the days or weeks following the birth. A sudden onset of heavy, bright red bleeding after the initial lochia had begun to lighten is a strong indicator of this complication. Other warning signs include a persistent, foul-smelling vaginal discharge, which suggests a uterine infection, or the development of a fever. Unexplained abdominal pain or cramping may also occur.
Treatment for a retained placenta must be swift. An obstetric provider may first attempt manual removal or use medications like oxytocin to stimulate uterine contractions and expel the tissue. If these methods are unsuccessful, a surgical procedure such as a dilatation and curettage (D&C) may be necessary to safely remove all fragments from the uterine wall. An ultrasound scan is often used to confirm the presence of any remaining placental tissue.
When Clot Size Signals Hemorrhage
The size, frequency, and accompanying symptoms of clots can signal a medical emergency known as postpartum hemorrhage (PPH). PPH is defined by excessive blood loss, often caused by the uterus failing to contract adequately after birth. The most important metric for dangerous bleeding involves the size of the clots being passed.
Any blood clot larger than a golf ball or a lemon requires immediate medical evaluation. Passing multiple large clots within a short time frame, such as several within an hour, is also an urgent sign. Soaking through one maternity sanitary pad in an hour, or experiencing this saturation level for several hours, indicates a flow that is too heavy.
Systemic symptoms accompany heavy bleeding as the body reacts to significant blood loss. These include feeling dizzy, lightheaded, or faint, suggesting a sudden drop in blood pressure. Other symptoms are a rapid heart rate, breathlessness, or feeling unusually weak. Recognizing these physical signs alongside the size and frequency of clots is crucial for distinguishing normal lochia from a life-threatening hemorrhage.
Recognizing Venous Blood Clots (DVT and PE)
Postpartum blood clots can also refer to venous thromboembolism (VTE), a separate complication involving the circulatory system. Pregnancy and the postpartum period increase the risk of VTE, which includes Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE). DVT is the formation of a blood clot in a deep vein, most commonly in the leg, thigh, or pelvis.
Symptoms of DVT typically manifest in only one leg and include localized swelling, pain or tenderness, and warmth or redness in the affected area. The pain may only be noticeable when walking or standing, and the leg may feel heavy. Since some leg swelling is common postpartum, any unilateral, sudden, or severe symptoms should be checked by a healthcare provider.
A Pulmonary Embolism (PE) is a medical emergency that occurs if a DVT clot travels to the lungs, blocking a blood vessel. PE symptoms are respiratory and cardiac, including sudden, unexplained shortness of breath, chest pain that worsens with deep breathing or coughing, and a rapid pulse. Coughing up blood, dizziness, or collapsing are severe signs requiring immediate emergency intervention.