How long does postpartum vaginal bleeding typically last after a vaginal delivery?

Duration of Postpartum Vaginal Bleeding After Vaginal Delivery

Normal postpartum vaginal bleeding (lochia) typically lasts up to 6 weeks after vaginal delivery, with the heaviest bleeding occurring in the first 24 hours and gradually decreasing over time.

Normal Progression of Postpartum Bleeding

Postpartum vaginal bleeding follows a predictable pattern that can be divided into three phases:

1. Lochia Rubra (Days 1-4)

   • Bright red bleeding similar to a heavy menstrual period
   • Contains blood, decidual tissue, and mucus
   • Heaviest during the first 24 hours after delivery

2. Lochia Serosa (Days 5-14)

   • Pink or brownish color
   • Thinner consistency with less blood
   • Contains serous fluid, blood, leukocytes, and tissue debris

3. Lochia Alba (Days 15-42)

   • Yellowish-white or cream-colored discharge
   • Contains leukocytes, decidual cells, epithelial cells, and bacteria
   • May last up to 6 weeks postpartum

Abnormal Postpartum Bleeding Patterns

It's important to distinguish between normal lochia and abnormal bleeding:

• Primary Postpartum Hemorrhage (PPH): Blood loss >500 mL within 24 hours after vaginal delivery 1
• Secondary Postpartum Hemorrhage (SPH): Significant uterine hemorrhage occurring between 24 hours and 6 weeks postpartum 1

Secondary PPH is less common, affecting 0.23-3% of all pregnancies 2, and is most commonly caused by:

• Retained placental tissue
• Subinvolution of the placental bed
• Infection 1

Risk Factors for Prolonged or Excessive Bleeding

Several factors can increase the risk of prolonged or excessive postpartum bleeding:

• History of previous secondary PPH (strongest predictor, OR 6.0) 3
• Vaginal bleeding prior to 24 weeks' gestation (OR 3.0) 3
• Primary PPH (OR 4.7) 3
• Maternal smoking (OR 2.7) 3
• Prolonged third stage of labor (OR 3.1) 3
• Incomplete third stage of labor (OR 2.1) 3

When to Seek Medical Attention

Women should seek immediate medical attention if they experience:

• Sudden heavy bleeding that soaks through one pad per hour for 2+ consecutive hours
• Passing large clots (larger than a plum)
• Foul-smelling discharge (suggests infection)
• Bleeding that increases rather than decreases over time
• Bleeding that persists beyond 6 weeks postpartum
• Severe lower abdominal pain
• Signs of shock (dizziness, tachycardia, hypotension)

Management Considerations

For healthcare providers evaluating abnormal postpartum bleeding:

• Ultrasound with Doppler is the first-line imaging modality to detect retained placental tissue or other causes of abnormal bleeding 4
• Retained placental tissue appears as a thickened endometrial echo complex with vascularity on Doppler 4
• Digital pelvic examination should be avoided until diagnoses such as placenta previa have been excluded 4

Key Takeaways

1. Normal postpartum bleeding (lochia) typically lasts up to 6 weeks after delivery
2. The pattern changes from bright red (days 1-4) to pink/brown (days 5-14) to yellowish-white (days 15-42)
3. Bleeding should progressively decrease in amount over time
4. Any deviation from this pattern warrants medical evaluation
5. A history of secondary PPH is the strongest risk factor for recurrent abnormal bleeding

Understanding the normal duration and progression of postpartum bleeding helps distinguish between physiologic lochia and pathologic bleeding that requires intervention.