lochia - is a physiologically due to postnatal discharge from the uterus, consisting of mucus exudate, impurities small amounts of blood and fragments lose their viability decidua.In fact, postnatal discharge from the uterus can be considered a secret wound.When the lochia leave the uterus and out, in their composition is already present cervical mucus and vaginal fluid contents.Such associated "impurities" can affect the appearance and consistency of lochia.
Postpartum lochia manifest the beginning of involution - the normal process of the return of the uterus to its original, pre-natal, state.The number and color of lochia changes as recovery of previous size of the uterus, the tone of the muscular wall and healing inner mucus layer.Complete disappearance of the lochia on the background of physiological postpartum period is the end of the recovery phase.
To have a correct understanding of the mechanism of occurrence of lochia, you must understand the essence of physiological and
uterus, acting as the genitals, has a complex structure, allowing it to carry and give birth to a child, and after childbirth to return to its original state.Uterine wall consists of several layers of performing a specific function:
- performs the function of protecting the external, serous layer (perimeter) is part of the abdominal cover.With uterine it smoothly into the neighboring organs.
- Thick and incredibly powerful muscle layer (myometrium) is represented by several types of muscle fibers arranged in a spiral, as well as strengthen their elastic fibers.The structure of the myometrium is unique, because the uterus for the gestation period increases in size many times, and during childbirth it is able to push the baby out through the mechanism of muscle contraction.
- internal mucous layer lining the uterine cavity (endometrium).Is gormonalnozavisimyh cloth.By "control" of estrogen in the endometrium occur cyclic structural changes.In the first half of the menstrual cycle, the endometrium is increased in volume, sprouting of new blood vessels.After ovulation, if pregnancy has not occurred, the amount of estrogen decreases, and the changes of the mucous liquidated: overbuilt mucous begins to be torn away, and during menstrual bleeding all the "unnecessary" part of the uterus and endometrium leaves out expires.
If the pregnancy, the endometrium thickens to the ovum, and plunged into a well-recorded.For normal growth, nutrition, respiration and excretion of metabolic products formed in the uterus placenta - a temporary additional organ.It attaches to the uterine wall and literally grow into the endometrium loose in a place called "placental site" and is connected to the fetus via the umbilical cord.Placenta yourself, like hormonal gland synthesizes progesterone, lowers the tone of the uterus and prevent premature labor.
Pregnant outer, functional layer of the endometrium, which is rejected by the pregnancy cycle, for the proper formation and gestation is converted into a so-called decidua lining the entire inner surface of the uterus, surrounding the fetus.
in childbirth reinforced reduce uterine muscles initially pushed out the fruit, and then release the placenta from the uterine cavity.
Thus, after delivery of the placenta and the uterus remains decidua tissue, liquid and thrombosed blood, destroyed muscle cells, mucus, and placental site there is an extensive wound surface.All this gradually evacuated uterine contents out in the form of postpartum discharge - lochia.Epithelialization of the damaged epithelium in the uterus occurs simultaneously with the rejection decidua tissue and fully completed by the tenth day after delivery.Damage in the area of endometrial placental site heals much more slowly.Fully endometrium takes on the original appearance in only six weeks, and at the same time must stop postpartum lochia.
lochia - a normal postnatal discharge refers to the process of purification and healing of the inner surface of the uterus.Their presence should not cause concern if they gradually quantitative decrease and disappear after 3-6 weeks after birth.Color lochia should also gradually changes from bright red to almost transparent.
lochia after childbirth
As already mentioned, lochia appear immediately after birth and continue until the full return of the uterus to the "prenatal" state and the restoration of its epithelial layer.The name of the post-natal selection received in ancient times, when they were considered for "postpartum cleansing", and their presence was interpreted as a cleansing of the body from "impure" blood in the veins, which appeared as a result of pregnancy.However, in fact lochia can not be only royal secret, because after expiration of the uterus are attached discharge the contents of the cervical canal and vagina.
about how physiological flows postpartum period can be judged by the color and the number of postpartum discharge.Abundant red lochia, usually seen in the first two or three days after birth, and ten days later they may become slimy and scarce.
appear lochia after childbirth gave birth at all, but their nature and duration vary considerably and depend on the course of labor and the postpartum period.That is lochia are directly dependent on the process of involution of the genitals.
So what happens with the sexual organs in the postpartum period?
After delivery of the placenta due to a sharp reduction in the uterine muscles of the uterus is significantly reduced in size, taking the form of a ball.However, supporting the uterus ligaments can not quickly cut like myometrium, so remain stretched longer and are the cause of the increased mobility of the uterus.
cervix significantly injured while advancing on her fetus.Its walls pererastyagivayutsya greatly and become very thin, slimy toiling, outer jaws widen and the cervical canal passes freely into the uterine cavity of the hand.Postpartum cervix is similar to a thin-walled bag hanging from the vagina torn edges.
most intense uterine involution occurs in the first two days after the birth of the fetus.A few hours after birth the tone of the pelvic and vaginal muscles is reduced, and they tighten up the uterus and the size of the uterus in a day reduced by half.
supervise the recovery period and the rate of possible method for determining the localization of the uterus, which is palpated directly through the abdominal wall.The doctor puts the edge of his hand on her stomach and gently pushing, probes the uterus.For diagnostic criterion adopted position of the bottom of the uterus with respect to the conventional horizontal line passing through the navel.As the progression of involution uterus process quickly drop below this line, and at the end of the period for the full restoration of localized womb.Palpation to determine the exact size of the uterus and its rate of involution is difficult, if necessary, more accurate diagnosis an ultrasound scan.It also allows you to see the structural changes occurring in the endometrium.
the inside surface of the uterus after childbirth similar to extensive wound, most expressed destructive processes in the area of placental site.The uterine cavity may present a significant amount of blood, and blood clots.Lumen-exposed uterine vessels after childbirth sharply narrows blood to clot and form clots to stop bleeding, so the first two days of bloody lochia may contain small clots.
in the process of uterine involution involved muscle, connective tissue and vasculature of the myometrium.
healing of the inner layer of the uterine wall begins with the collapse and subsequent rejection of scraps of decidual tissue, and with it goes out clotted blood and other tissue structures are rejected destroyed.Such isolation and post-natal are lohiyami.
Within six weeks of the uterine cavity expires 500 - 1500 ml of lochia.The first two days are observed abundant bright red lochia.Then, when the vessels and stop bleeding thrombosing character precipitates gradually changed.Three days later, the bright bloody lochia changes to a darker, brownish-red highlight.Brown manifest lochia stop bleeding in the uterus.A week later, they are replaced by yellow lochia, which gradually become slimy and light.
If labor and subsequent postpartum period proceeded in accordance with the physiological norm, allocation lochia completed not later than six weeks after childbirth.
flow postpartum period, and hence the rate of involution, largely depend on how the birth.When multiple pregnancy the uterus reaches its maximum size, the muscular layer in childbirth experiencing considerable strain, so the recovery period after birth, including the involution of the uterus, can last longer.
Breastfeeding is also the key to the success of the involution, since at the time of feeding the body synthesize oxytocin, which helps the uterus to contract.
lochia after delivery correlated with the physiological norm, if they:
- quantitatively gradually reduced;
- change color from red to clear;
- not accompanied by severe pain, fever;
- does not contain impurities in the form of pus;
- completed six weeks after childbirth.
sudden withdrawal of lochia expiration indicates the possible formation lohiometry.It occurs in violation of the outflow of postpartum discharge, when the uterine cavity is accumulated a significant number of them.This condition can be caused by blockage of the cervical canal large blood clots, remnants of the placenta or cervical spasm in the background atony uterine wall.
lochia after cesarean
Cesarean section - a surgical method of delivery.It is considered the most prevalent surgery.There are many methods of execution of the operation, but the essence of each of them is reduced to extracting the fetus through an incision on the uterus, followed by its stratified suturing.The integrity of the uterine wall is restored, but the former site of the cut portion is formed solid scar tissue.Postoperative scar on the uterus is preserved for life.
involution of the uterus after childbirth involves surgically performed with a number of complications can occur and is more durable.If the operation is successful, and the postoperative period without significant complications, duration of lochia after cesarean section is not higher than that of a natural birth.
After surgery, the body not only need to clean the uterine cavity and restore the mucous layer.Also, there is a healing of surgical wounds.Available postoperative scar on the uterus makes it difficult to reducing the muscular wall and exhausted by pregnancy and childbirth immune system can not actively participate in the reconstruction process.The weaker the contractile ability of the uterine wall, the longer the process of involution, and the longer the lochia.Significant reduction in uterine tone (hypotonia) or lack thereof (atonic) are fraught with the development of infection, can cause the formation of lohiometry or provoke uterine bleeding.
After Caesarean section the uterus alone is not able to restore tone, so support is needed medication.Used stimulants contractility of uterine wall - uterotonics (oxytocin, metilergometrina).They are administered intramuscularly, and control the dynamics of movement of the pelvic floor.
duration of lochia after cesarean section, as well as after normal childbirth, does not exceed six weeks.Their number and external characteristics are different.
Anxiety lochia after cesarean section should call if:
- they suddenly stopped prematurely or have become very scarce;
- pain appeared in the projection of the uterus, especially in conjunction with a high temperature;
- they include many major bleeding clots;
- they became too much (criterion - need to change more than one pad per hour);
- lochia bleeding does not stop after one week;
- they suddenly again become bright red or pus-like;
- they have an unpleasant putrid odor.
It should be remembered that not all vaginal discharge after birth may be related to lohiyami.With infectious inflammation in the cervix and / or vagina may appear abundant purulent or serous-purulent leucorrhoea, non lohiyami, but they are attached to the mother is separated off and change the amount, appearance and texture.
So, sometimes after surgery lochia become similar to cottage cheese and soured milk.This change is related to the antibiotics that are prescribed for the prevention of septic complications.Because of the local dysbiosis vagina multiplies fungal infection, and symptoms of candidiasis (thrush).
determine the true nature of atypical postpartum discharge can only doctor and laboratory study helps to establish their microbial and cellular composition.
How lochia last
duration of lochia has no clear criteria.It depends on many factors:
- the weight and size of the fetus;
- the volume of amniotic fluid (they also stretch the uterus);
- amount to bear children;
- comorbidity (eg, chronic infection);
- the state of the blood coagulation system and immunity;
- the presence of complications in childbirth and after;
- mode of delivery (through the birth canal, or surgical).
Early initiation of breastfeeding stimulates the rate of involution of the genitals after birth and reduces the period of lochia.
Determine the mean duration of postpartum discharge:
- The first two days are similar to menstrual lochia bright red highlight.In their structure is dominated by red blood cells.
- the third and fourth day, the amount of fresh blood in the discharge from the uterus decreases, lochia become darker, becoming brownish-red tint.Brown lochia connected by blood vessels in the uterus that do not bleed, and which has many leukocytes.
- A week may appear yellow lochia.The appearance of the mucus secretions in the postpartum and the almost complete disappearance of the red blood cells gradually "decolorized" lochia.
- Ten days lochia lose yellowish hue and become light.
- Against the background of the full restoration of the mucosa in three weeks lochia acquire the character of normal vaginal discharge, but the number may still be a little more.
complete disappearance lochia should occur no later than six weeks after the birth or caesarean section when the tone of the uterus and its internal structure are reduced to prenatal values.
sometimes occurring after childbirth early menstruation a woman is mistaken for returning lochia.One and a half or two months of non-breastfeeding postpartum breast may come first postpartum menstruation, which means the completion of all the processes of involution and restore hormonal levels.In lactating mothers due to increased prolactin menstruation occurs later, it often appears after the cessation of the lactation period.
Regardless of how a young mother giving birth can help your tired from the heavy "work" of the body to recover and prevent the development of infectious complications.It's enough just to perform burdensome rules:
- good hygiene regime.It is necessary to keep the body and intimate area clean, regularly taking a shower.
gaskets should be replaced after three hours, even when they are impregnated slightly.
strictly forbidden to use tampons.