Lochia is the medical term for the vaginal discharge that occurs after delivery, consisting of blood, mucus, and tissue from the uterine lining. This discharge is a natural sign that the uterus is shedding materials and returning to its pre-pregnancy size. While lochia is a normal part of postpartum recovery, monitoring its characteristics is important for maternal health. Understanding the typical changes in lochia helps to quickly identify when the healing process may be complicated by an infection, which requires immediate attention.
The Normal Progression of Lochia
Lochia follows a predictable, three-stage course as the uterine wound heals over several weeks. The initial stage, lochia rubra, lasts for the first three to four days after delivery and is characterized by a heavy flow of dark or bright red blood. During this period, it is common to pass small blood clots, similar in size to a grape or raisin, as the body expels leftover tissue and blood.
The discharge then transitions into lochia serosa, which begins around day four and continues for up to a week or more. The color changes to a pinkish-brown or reddish-brown hue, and the discharge becomes more watery and significantly lighter in volume.
The lochia enters its final phase, called lochia alba, typically starting around ten to fourteen days postpartum. Lochia alba is a yellowish-white or creamy discharge with very little blood, consisting mostly of white blood cells, mucus, and uterine cells. This final stage can last for up to six weeks postpartum before tapering off completely. Normal lochia has a distinctive odor, often described as musty, stale, or metallic, similar to menstrual blood.
Identifying Infected Lochia
The most reliable indicator that lochia is infected is a significant change in its smell. Normal lochia has an earthy, musty scent, but infected lochia often develops a distinctly foul, putrid, or extremely strong odor, sometimes described as fishy. This unpleasant smell results from the proliferation of bacteria within the uterus, a condition often referred to as postpartum endometritis.
Changes in the color and consistency of the discharge can also signal a problem. A key visual warning sign is the lochia reverting to a bright red color and heavy flow after it had already progressed to the lighter pink (serosa) or yellowish-white (alba) stages. This reversal suggests that the uterine healing process has been disrupted or that an infection is causing new bleeding.
Infected lochia may also appear greenish in color or contain large, excessive clots that form after the first few days postpartum. While passing small clots is normal initially, the sudden appearance of large clots, or a flow so heavy it soaks a sanitary pad in under an hour, can indicate a complication like hemorrhage. A reduced or suddenly absent flow of lochia, especially when paired with systemic symptoms, may also be concerning, suggesting that infected matter is trapped inside the uterus.
Accompanying Symptoms of Postpartum Infection
Infected lochia is often one component of a broader postpartum infection, which presents with several systemic signs. A temperature of 100.4°F (38.0°C) or higher, which is sustained or recurs, is a primary indicator of a puerperal infection. This fever is frequently accompanied by chills or shivering.
Infections of the uterus, such as endometritis, commonly cause severe or worsening abdominal and pelvic pain. This discomfort is typically felt as uterine tenderness and is not relieved by standard over-the-counter pain medication. The pain may be localized to the lower abdomen, reflecting inflammation of the uterine lining and muscle.
Other signs of a widespread infection include an increased heart rate, or tachycardia, as the cardiovascular system attempts to compensate. Women often report a general feeling of being very unwell, known as malaise, along with loss of appetite and body aches.
Next Steps and Treatment Overview
If any signs of infected lochia or accompanying systemic symptoms are present, immediate consultation with a healthcare provider is necessary. Postpartum infections, while treatable, can progress rapidly and must be addressed without delay to prevent serious complications like sepsis. The healthcare team will conduct a physical examination, noting uterine tenderness and the characteristics of the discharge.
Diagnosis
Diagnosis is often supported by blood tests, which can show an elevated white blood cell count, confirming the presence of an infection. In some cases, cultures of the lochia or blood may be taken to identify the specific bacteria causing the infection.
Treatment
Treatment for postpartum endometritis generally involves the prompt administration of broad-spectrum antibiotics to target the multiple types of bacteria typically involved. For moderate to severe cases, or those following a cesarean delivery, antibiotics are often administered intravenously (IV) in a hospital setting, commonly involving a combination such as clindamycin and gentamicin. Patients typically begin to feel significantly better within a few days of starting treatment. Mild infections may sometimes be treated with oral antibiotics at home, but the decision rests entirely with the medical team based on the infection’s severity.