Types of lochia (in order of occurrence).
(a) Lochia rubra-a red, distinctly blood-tinged vaginal flow that follows
delivery. It lasts from two to four days after delivery.
(b) Lochia serosa-a serous, pinkish brown, watery vaginal discharge
that follows lochia rubra. It lasts until about the 10th day after delivery.
(c) Lochia alba-a thin, yellowish to white, vaginal discharge that follows
lochia serosa on about the 10th post delivery day. It may last from the end of the third
to the sixth post delivery week.
Lochia with a foul-smell or a green-tinge may indicate infection.
Lochia clots whereas normal menstrual flow does not.
Normal lochia flow should stop within three to four weeks postpartum.
(5) An increase in lochia flow may indicate a retained placenta or a patient
who is not getting enough rest.
(6) Lochia flow is slightly heavier after breast-feeding, which is due to the
release of oxytocin. Oxytocin causes the uterus to contract.
c. Changes in the Cervix. Initially, the cervix appears soft and edematous and
has little tone. Multiple small lacerations may be seen. The cervix constricts rapidly
and regains its shape by the end of the first week. Then, it is firm and thicker. The
external os is contracted, only about one cm dilated. The cervix is healed by the fourth
to sixth week after delivery. The extended os will assume a typical transverse slit of a
d. Changes in the Vagina. Initially, the vagina is swollen and has poor tone
following vaginal delivery. It remains distensible, regains its tone and returns to its
original size by the fourth to sixth week of the postpartal period. The patient can help to
improve tone and contractibility of the vaginal orifice by performing the Kegel's exercise
(perineal tightening). Lacerations resulting from childbirth heal completely.
e. Changes in the Perineum. Initially, swelling and tenderness as a result of
childbearing is present. Bruising and rupture of blood vessels are usually evident. By
the fourth to sixth week postpartum, the episiotomy or laceration is usually evident.
There is no more swelling and tenderness in the perineum area.
CHANGES IN THE CARDIOVASCULAR SYSTEM FOLLOWING DELIVERY
a. Blood Volume. Initially, there is a 15 to 30 percent increase in circulating
blood volume the first 20 days of postpartum. This results from the elimination of