Question

9) A woman gave birth at 0600 and it is now 1000. She calls you to her room to check in on her vaginal bleeding. She describes her bleeding as bright red, leaking about three quarters worth of blood on her pad since her last pad change at 0730, and a clot the size of a pinky fingertip. You go to assess her loch (afterbirth bleeding) and find her description to match your objective findings.

Is this normal or abnormal?

What can you tell her about this stage of lochia?

What can you tell her to expect for her lochia in the coming days to weeks?

10) You check on the fundal height of the patient in question 9 to get some more information. You notice that her fundus is at the level of the umbilicus. Is this normal? Where would you find the fundus by day 2 and day 10-12?

Answer 1

9)

A) It is normal. After delivery, the bleeding will be heavy in the first few days. The blood color will be bright red and it is normal to see some small blood clots in the lochia.

B) This postpartum bleeding is called lochia rubra. It lasts 2 to 4 days with heavy bright red bleeding with clots. If the patient gets larger clots, it should be evaluated. Otherwise, it is a normal to see the clots in post- delivery bleeding .

C) Postpartum bleeding is a normal process of the body to expel extra blood and tissue that helped the baby growth. It has 3 stages.

First one is Lochia Rubra which lasts 2-4 days and the blood appears bright red with small blood clots.

The next stage is Lochia serosa. It starts at Day 4 and lasts about 2 weeks. In this stafe, the blood color will chage from red to watery pink.

Finally, Lochia Alba which lasts 2 to 6 weeks postpartum. The blood color changes from pink to yellowish or whitish color. However, the patient still experiences spotting in between.

If any abnormal bleeding patterns, foul smell or large clots appears in these periods, it should be reported immediately to the doctor.

10) The uterus starts involution process immediately after the delivery of the placenta. It takes almost 4-6 weeks to complete the process. One hour post delivery, the fundus appears firim and at the level of the umbilicus. The fundus continues to descend into the pelvis at the rate of approximately one centimeter (finger-breadth) per day and it should be nonpalpable by two weeks postpartum. In day 2, it can be felt at below the  belly button. By day 10, it cannot be palpable above the pubic bone.