What is the duration of postpartum hemorrhage (PPH) or lochia?

From the Guidelines

Postpartum bleeding, known as lochia, typically lasts about 4-6 weeks after childbirth. The bleeding is heaviest during the first few days (lochia rubra), similar to a heavy menstrual period, and gradually decreases in amount and changes color over time 1. After about 3-10 days, it transitions to a pinkish or brownish discharge (lochia serosa), and then to a yellowish-white discharge (lochia alba) before stopping completely.

Key Points to Consider

• The duration of postpartum bleeding can vary among women, but it is generally defined as any hemorrhage associated with signs or symptoms of hypovolemia within 24 hours of delivery, regardless of the type of delivery 1.
• Secondary or late postpartum hemorrhage is typically defined as any significant uterine hemorrhage occurring between 24 hours and 6 weeks postpartum 1.
• While this bleeding is normal, it is essential to contact a healthcare provider if you experience very heavy bleeding (soaking through more than one pad per hour), passing large clots (bigger than a quarter), foul-smelling discharge, or if bleeding suddenly increases or returns to bright red after lightening.

Recommendations for Management

• Rest, proper hygiene, and using sanitary pads rather than tampons during this time are recommended to reduce infection risk and allow proper healing.
• Conservative measures such as uterine tamponade with either packing or balloon catheter and massage, uterotonic medications, and correction of coagulopathies are the first line of treatment for postpartum hemorrhage 1.
• Once a specific diagnosis has been identified, tailored intervention such as curettage for retained products of conception, embolization for vascular uterine anomalies, antibiotics for infection, evacuation of large bladder hematoma, or surgical repair for uterine rupture can be performed 1.

From the FDA Drug Label

Methergine® (methylergonovine maleate) may be administered orally for a maximum of 1 week postpartum to control uterine bleeding. The duration of postpartum bleeding is not directly stated in the drug label, but Methergine is administered for a maximum of 1 week postpartum to control uterine bleeding 2.

• The drug label does not provide information on the typical duration of postpartum bleeding.
• Postpartum bleeding is managed with Methergine for up to 1 week after delivery.

From the Research

Postpartum Bleeding Duration

• The duration of postpartum bleeding is not explicitly stated in the provided studies 3, 4, 5, 6, 7.
• However, postpartum hemorrhage (PPH) is a common complication of childbirth, and its management is crucial to prevent maternal morbidity and mortality 3.
• The studies focus on the prevention and treatment of PPH using various uterotonics such as oxytocin, methylergonovine, carboprost, and misoprostol 4, 5, 6, 7.
• The management of PPH involves identifying the underlying cause, estimating blood loss, and initiating a resuscitation protocol with fluid replacement, blood transfusion, and close monitoring of the woman 3.
• The duration of postpartum bleeding can vary depending on several factors, including the severity of the hemorrhage, the effectiveness of treatment, and individual patient characteristics.
• Further research is needed to determine the average duration of postpartum bleeding and to develop evidence-based guidelines for its management 3, 4, 5, 6, 7.

Uterotonic Medications

• Oxytocin is the first-line agent for preventing and treating uterine atony, a common cause of primary postpartum hemorrhage 6.
• Methylergonovine and carboprost are highly effective second-line agents, but they have severe potential side effects 6.
• Misoprostol is a useful therapeutic agent in resource-limited practice environments, but its effectiveness as an adjunct to other uterotonic agents has been questioned 6.
• The choice of uterotonic medication depends on various factors, including the severity of the hemorrhage, patient characteristics, and the availability of resources 3, 4, 5, 6, 7.

Prevention and Treatment of Postpartum Hemorrhage

• Active management of the third stage of labor is crucial for preventing PPH, and oxytocin administration is the criterion standard 3.
• The use of uterotonics, such as methylergonovine and misoprostol, can help prevent and treat PPH 4, 5, 7.
• Intrauterine balloon tamponade and other surgical interventions may be necessary in cases where medical management fails 3.
• The development of consistent international practice protocols for the effective management and prevention of PPH is essential to improve obstetric outcomes and reduce maternal mortality 3.