What discharge after childbirth is considered the normwhich pathologies

Update: October 2018

All new mothers and, of course, doctors, their
observers, concerned about the discharge after the birth of the child. how many
after childbirth go discharge – the question is by no means idle, but rather
current. Answer the question of whether everything is “calm in Danish
Kingdom ”allows the assessment of postpartum excreta and their
smell.

Little postpartum

It is clear that the postpartum period begins immediately after
childbirth, that is, the birth of the afterbirth (placenta), and not the child. And how much
he goes on, few know. There are 2 stages after childbirth:

  • early postpartum, which lasts 2 hours,
  • Late postpartum period of 6 to 8 weeks.

What happens in the postpartum period? As soon as the last
separated from the wall of the uterus, it stands out or is born. On
its place in the mucous uterus formed a wound surface, where
there are gaping blood uterine vessels from which it expires
blood. The uterus immediately begins to contract, and in the process of these
contractions of the uterine wall tense, thereby compressing the torn
vessels

During the first two hours, the excretions are bright bloody,
moderate. Normal blood loss in the early postpartum period
is not more than 0.4 l or 0.5% by weight of the puerperal.

In the case of increased bleeding after childbirth is necessary
first eliminate hypotonic bleeding and then
unnoticed and not sutured rupture of the perineum, vaginal walls or
cervix.

If the uterus weighs about 1 kg immediately after the birth of the baby seat,
then to the end of the postpartum period, she returns to her
normal size and weight, 60 – 70 grams. To achieve this
the uterus continues to contract, but not as hard and painful as in
fights. A woman can only feel small spasms down.
abdomen, which are strengthened when the baby is attached to the breast
(since nipple stimulation triggers the release of a hormone,
activating contraction of the uterus – oxytocin).

For the stipulated 6-8 weeks, the uterus must be returned to
normal size and heal the wound surface – all this
the process is called postpartum uterine involution. During the first
days after birth, the edge of the uterus is palpated at the level of the navel. TO
on the fourth day its bottom is in the middle of the distance from
umbilical fossa to the bosom. On 8 – 9 день дно матки выступает из-за лона
about 1 to 2 cm, so the day the uterus is reduced by 1
cm.

Postpartum discharge is called lochia, and depending
from their color, smell and quantity judge how flows
postpartum period. Lochia is a physiological secret
ancestral wound, which include the decidual membrane,
red and white bloody bodies, lymph, plasma and mucus. AT
eventually, after a month, postpartum discharge is normal
are missing.

Read also on the topic:

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  • Uterine bleeding
  • Transparent stretching mucous discharge
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  • Dramatic weight loss after childbirth is dangerous
  • ATросший ноготь на ноге после родов
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  • Causes of pain in the mammary glands
  • Anal fissures after childbirth
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  • Why legs swell
  • Pain during intercourse
  • TOак увеличить лактацию
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  • After the first two hours after birth, the discharge becomes
    dark red or brownish and moderate. Such discharge
    last from 5 to 7 days.
  • The first 3 days, their total volume is 300 ml, which requires a change
    padded diaper every 2 hours. AT выделениях могут быть сгустки
    blood, and there is nothing terrible.
  • Onчиная с 6-7 дня (неделя после родов) выделения меняют цвет и
    become yellowish or whitish. Color is determined by the content
    in the discharge of large numbers of white blood cells that are involved in
    healing of the postpartum wound.
  • From 9 to 10 days, the discharge appears as watery, bright.
    shade and large amounts of mucus, their volume gradually
    decreases. At first this is a scanty discharge, and then become
    almost imperceptible, and disappear by 3 – 4 weeks.

Subinvolution of the uterus

About the physiological course of the postpartum period is judged by
as uterine contraction proceeds, the mucous membrane is separated and from
uterine cavity go out blood clots.

Reverse development of the uterus – involution plays an important role in
physiology of puerperal – recovery of menstrual and
reproductive functions. TOогда же сократительная способность матки
weakened then there is a threat of postpartum
purulent-septic complications.

To assess the process of postpartum involution of the uterus puerperal
invited to the reception 10 days after discharge, where
general and gynecological examination.

Subinvolution of the uterus — замедленный возврат к прежним параметрам.
If during a gynecological examination the doctor palpates soft
loose uterus, which has a significant size (about 10 – 12
weeks), not shrinking at hand, talking about subinvolution.

To confirm the diagnosis of postpartum subinvolution in
necessarily conducted pelvic ultrasound, which will allow
identify the causes that prevent normal uterine contraction
(remnants of the placenta or fetal membranes).

Predisposing factors for subinvolution of the uterus can be:

  • preeclampsia
  • multiple pregnancy
  • polyhydramnios
  • childbirth protracted or swift
  • uterine fibroids

ATопрос о госпитализации женщины решается в индивидуальном
okay If there are no complaints, general condition
satisfactory, and in the uterus there are no residues of afterbirth or membranes,
uterotonic drugs (tincture of water
pepper, oxytocin or methylergometrine).

AT случае обнаружения инородного содержимого в матке проводится
its evacuation by vacuum suction and, in some situations, diffuse
washing the uterus with antiseptic and / or antibiotic solutions. WITH
antibiotics are prescribed for a prophylactic short cycle.
(duration 2 – 3 days).

Lohiometry

Lohiometry также относится к послеродовым осложнениям и
characterized by delayed lochia in the uterus. TOак правило, лохиометра
develops on 7 – 9 day after birth. Causes
This complication is different:

  • It can be as a mechanical blockage of the cervical canal.
  • So insufficient uterine contractile activity
  • A mechanical obstruction in the cervical canal can create
    blood clots, decidual and / or fetal remnants
    shells
  • Or excessive bend of the uterus anteriorly

When over-stretching the fetus during pregnancy
(большие размеры плода, polyhydramnios или многоплодие) или в процессе
childbirth (discoordination of labor, prolonged or
rapid delivery, cesarean section, neck spasm)
contractility of the uterus weakens. When timely
diagnosed lohiiometr general state of the puerperal remains
satisfactory, the temperature and pulse are normal, the only
a sign is the absence of lohii or their number is negligible
few.

Palpation of the uterus is marked by an increase in its size.
compared with the previous day and pain. Missed
lohiometry leads to the development of endometritis. ATрачебная тактика
is to create an outflow of lochia from the uterus. WITHначала назначается
conservative therapy:

  • no-spa or papaverine parenterally
  • then uterotonics (oxytocin) and cold to the lower abdomen

If uterus inflection is diagnosed, a bimanual is performed.
palpation to return it to its original position.

When a cervical canal is blocked, the doctor gently fingers it.
expands (in some cases, extenders may be needed
Gegara) and frees him.

ATыскабливание — если после оказанных мероприятий на протяжении 2
– 3 days of lohiometer not eliminated, resort to instrumental
emptying the uterine cavity (curettage) or to vacuum aspiration. WITH
antibiotics are prescribed for prophylactic purposes.

Postpartum endometritis

Another, but more dangerous complication of the postpartum period
is inflammation of the uterus or endometritis. TOак известно, у всех
Pregnant women are weakened by immunological protection, which is necessary for
prevention of rejection of the ovum as a foreign body.
The body’s defenses are restored on days 5-6.
births that ended naturally and on the 10th day after
abdominal delivery. Therefore, all puerperas are threatened by
the development of inflammatory diseases of the reproductive organs
system.

But there are a number of factors that predispose to
the occurrence of postpartum endometritis:

ATо время беременности

ATо время родов

Are common

  • late toxicosis (after 20 weeks)
  • anemia of pregnant women
  • malposition
  • large fruit
  • polyhydramnios
  • multiple pregnancy
  • surgical treatment of cervical insufficiency
  • inflammation of the vagina and / or cervix
  • exacerbation of chronic inflammatory diseases in the period
    carrying
  • any infectious disease during pregnancy
  • pathology of the placenta (previa or low placentation)
  • threat of interruption, especially permanent
  • placental abruption
  • infection of the birth canal on the eve of childbirth genital
    infections
  • clinically narrow pelvis
  • preterm labor
  • anomalies of generic forces (discoordination, weakness)
  • cesarean section
  • obstetric benefits during labor
  • long anhydrous period (more than 12 hours)
  • manual control of the uterus
  • prolonged labor
  • frequent vaginal examinations to determine obstetric
    situations (more than three)
  • age (less than 18 and over 30 years old)
  • burdened gynecological history (inflammatory
    diseases, abortions (complications), fibroids, etc.)
  • endocrine pathology
  • bad habits
  • poor nutrition;
  • adverse living conditions
  • cesarean section в анамнезе
  • chronic extragenital diseases

WITHимптомы острого эндометрита

  • Endometritis begins acutely, usually from 3 – 4
    days.
  • Puerperess notes that the discharge became brown or color
    meat slop.
  • Then the lochia become purulent and become
    greenish shade.
  • An unpleasant smell is also characteristic during discharge after childbirth.
    (rotten meat).
  • WITHтрадает и общее состояние пациентки. The temperature rises to
    febrile numbers (38 – 39 degrees), rapid heartbeat,
    There is a pronounced weakness, malaise.
  • AT анализе периферической крови воспалительные явления
    (возрастание WITHОЭ, лейкоцитов).

Subacute endometritis is more often diagnosed later, after
discharge from the maternity hospital

  • A woman can only note that the discharge continues
    stay bloody up to 10-12 days.
  • The temperature may rise slightly or up to
    febrile numbers.
  • ATыделения после родов становятся гнойными и приобретают
    unpleasant smell when a woman ignores previous signs
    only in 3 – 5 days.
  • AT любом случае, послеродовый эндометрит является показанием для
    hospitalization.

AT стационаре женщине обязательно проводится гистероскопия для
exclusion or detection of residues of placental tissue, fetal
shells и сгустков крови и последующего удаления их из матки
vacuum aspiration or scraping. Onзначается диффузное
washing the uterine cavity with antiseptic solutions and
antibiotics (minimum quantity 3). Then shown
parenteral administration of antibiotics.

The child has grown up, but what about the mother?

TOак уже говорилось, в норме лохии после рождения ребенка
stop by the end of 3 – 4 weeks. If a woman is not breastfeeding,
then her menstrual cycle is restored, which can be noticed
by the nature of the discharge. WITHначала были слизистые, умеренные, потом
(about a month or 2 after childbirth) whites became abundant and
similar to raw egg white for 2 to 3 days, which
indicative of ovulation.

Therefore it is important to resolve all questions about postpartum contraception.
advance with the doctor. If the mother is nursing, then by the time of execution
she becomes moderately slimy on the baby of the month
unpleasant smell, and do not change their character throughout
breastfeeding stage.

But in a situation when yellow discharge appeared after childbirth
(after the end of lohii), the mother must be alert. Special,
if such whites have a pronounced yellow color, they have
unpleasant smell, and the woman herself is worried about itching and discomfort in
area of ​​the external genitalia or vagina. TOонечно,
it is necessary to visit a doctor as soon as possible, and not to postpone the visit
to him “for later.”

Only a doctor will be able to determine the cause of the pathological whiter,
will take a smear on the vaginal microflora and will recommend
соответствующее лечение (cm. лейкоциты в мазке). AT лучшем случае,
if yellow discharge will be a sign of colpitis (genital tract
women who gave birth are highly vulnerable to infection, and
the body is weakened by pregnancy, childbirth and child care). If a
in addition to yellow discharge and the above signs of a woman
distressing fever and lower pains
the stomach, then the more difficult to delay, because it is possible that goes
inflammation in the uterus or appendages.

Postpartum Hygiene

In order for the uterus to contract and return to its normal
�“Before the age” sizes, it is necessary to observe uncomplicated after childbirth
regulations:

  • sleep preferably on the stomach, which creates pressure on the uterus and
    contributes to its reduction, and also has a uterus and a neck on
    single axis, resulting in improved outflow of lochia
  • to go to the toilet at the first call of his body, and not
    postpone this event (full bladder and direct
    the intestine prevents contractions of the uterus)
  • regular change of gasket (no later than two hours, since
    Lochiae are an excellent breeding ground for bacteria that
    creates a risk of infection of the genital tract)
  • categorical ban on tampons in the postpartum period
  • wash at least twice a day with boiled water, you can
    weak potassium permanganate solution
  • stick to free feeding when baby
    applied to the chest on demand (nipple stimulation helps
    oxytocin synthesis)

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