Bloody lochia lasts longer

Introduction The most prominent clinical manifestation of uterine incompetence is the prolongation of bloody lochia, extending from normal only for 3 days to 7 to 10 days or even longer. If the disease is due to the placenta residue, the bloody lochia lasts for a long time, and the blood volume is also significantly increased. At this time, the lochia is often cloudy or accompanied by odor. After childbirth, due to the contraction and contraction of the uterus muscle, the vascular lumen is blocked or narrowed in the muscular layer, the uterine muscle cells are ischemic or autolyzed, the uterus volume is significantly reduced, and the placental dissection surface is also reduced and regenerated with the uterus. The inner membrane is grown to be repaired. Generally, it can be restored to non-pregnant state within 5 to 6 weeks after delivery. This process is called the aging of the uterus. When the above functions of the old and the old are hindered, the uterus is incomplete.

Cause

Causes of prolonged duration of bloody lochia:

The main reasons that affect the uterine involution and lead to uterine incompleteness are:

1. Placenta, residual membrane, and decidual detachment are incomplete.

2. Endometritis, uterine myositis or pelvic infections.

3. Uterine fibroids, such as uterine myometrial fibroids, adenomyoma (adenomyoma).

4. The uterus is excessively bent or laterally flexed, and the lochia is not discharged smoothly, causing the lochia to stay in the uterine cavity.

5. Excessive placenta area (such as multiple pregnancy, placenta previa, etc.) affects the uterine involution, because the muscle layer of the placenta attachment site is thinner, the uterine contractility is significantly weakened.

6. Multi-partum women have a relatively increased uterine fibrous tissue due to multiple births, affecting uterine contractility.

7. Over-expansion of the bladder or the bladder is often inflated, with postpartum urinary retention being the most common. Common causes are residual part of placental membrane, endometritis, uterine myositis or pelvic infection caused by postpartum infection, due to uterine excessive stagnant or lateral flexion caused by lochia, uterine wall fibroids, uterine adenomyosis, Over-expansion of the uterus during pregnancy such as multiple pregnancy, excessive amniotic fluid, huge fetus, etc.

an examination

Related inspection

Abdominal MRI

Examination of prolonged duration of bloody lochia

The most prominent clinical manifestation of uterine insufficiency: the duration of bloody lochia is extended from normal only for 3 days, extended to 7 to 10 days, or even longer. If the disease is due to the placenta residue, the bloody lochia lasts for a long time, and the blood volume is also significantly increased. At this time, the lochia is often cloudy or accompanied by odor. Sometimes residual necrotic tissue and/or membrane tissue can be seen with the lochia. After the bloody lochia stops, if there is purulent secretion, it is accompanied by endometrial inflammation. During this period, the patient often has low back pain and lower abdominal bulge, but there are also a small number of patients with very little bloody lochia, mainly due to severe pain in the lower abdomen. If the double examination is performed, it is often found that the cervix is soft, and the external cervix can pass at least 1 finger. The uterus is slightly softer than the normal uterus at the same time. Most of the uterus is posteriorly tilted and has a slight tenderness. If the uterus is incomplete due to endometritis, uterine myositis or pelvic infection, the uterine tenderness is more obvious, and even the attachment area has different degrees of tenderness. According to the above symptoms and signs, it is not too difficult to diagnose uterine involution, but the diagnosis and finding the cause of the disease mainly depends on the curettage, and the tissue will be sent to the pathological examination to help confirm the diagnosis. At the same time, it is often necessary to use B-mode ultrasound.

Differential diagnosis

Symptoms of bloody lochia prolonged confusing:

Lochia during puerperium: After the delivery of the uterus, the decidua of the uterine decidua, especially the placenta attachment, is detached from the decidua, containing blood, necrotic decidua and other tissues. After the postpartum lochia lasts for more than three weeks, it is still dripping, which is called postpartum lochia.

Bloody lochia: bright red, containing a lot of blood, a lot, sometimes with small blood clots. There is a small amount of fetal membrane and necrotic tissue. Bloody lochia lasts for 3 to 4 days, the amount of uterine bleeding gradually decreases, and the serum increases, turning into serous lochia.

Postpartum lochia is not clean and smelly: late postpartum hemorrhage is manifested as postpartum lochia that is not clean and smelly. Repeated or sudden vaginal bleeding can lead to anemia, shock and even life-threatening. Late postpartum hemorrhage refers to a large amount of bleeding in the uterus that occurs during the calving period after 24 hours of delivery, and the amount of bleeding exceeds 500 ml. The most common morbidity occurred 1 to 2 weeks after delivery, and it was late to 6 weeks after birth. Also known as puerperal bleeding. The incidence of late postpartum hemorrhage is closely related to the quality of prenatal care and obstetric quality. In recent years, with the increase of cesarean section rate, the incidence of late postpartum hemorrhage has an increasing trend.

Lochia: After the delivery of the mother, the decidua of the uterine decidua, especially the placenta attachment, is detached. The blood containing the blood and the necrotic decidua are discharged through the vagina.

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