What is the typical duration of postpartum bleeding?

Duration of Postpartum Bleeding

Postpartum bleeding typically lasts between 24 hours and 6 weeks after delivery, with the heaviest bleeding occurring in the first 24 hours and gradually decreasing over time. 1

Normal Postpartum Bleeding Pattern

• Postpartum bleeding, also known as lochia, follows a predictable pattern after delivery 1:

  • First 24 hours: Heaviest bleeding (primary or early postpartum period) 1
  • 24 hours to 6 weeks: Gradually decreasing bleeding (secondary or late postpartum period) 1

• Normal postpartum bleeding characteristics include:

  • Initial bright red bleeding that gradually changes to a brownish or yellowish discharge 1
  • Presence of some blood clots in the first few days is normal 1
  • Gradual reduction in volume over the 6-week period 1

Abnormal Bleeding Patterns

• Primary Postpartum Hemorrhage (PPH): Excessive bleeding within the first 24 hours after delivery 1

  • Defined as blood loss >500 mL after vaginal delivery or >1000 mL after cesarean section 2
  • Requires immediate medical attention 2

• Secondary Postpartum Hemorrhage (PPH): Excessive bleeding between 24 hours and 6 weeks postpartum 1

  • Common causes include retained products of conception (RPOC), subinvolution of the placental bed, or infection 1
  • More common after vaginal delivery, while postpartum endometritis is more common after cesarean 1

Normal Postpartum Uterine Changes

• During the 6-week postpartum period, the uterus undergoes significant changes 1:
  • The endometrial cavity contains debris and sometimes gas in 20-25% of women in the early postpartum period 1
  • Thickened endometrial echo complex up to 2-2.5 cm in diameter is normal in the early postpartum period 1
  • The uterus gradually returns to its pre-pregnancy size (involution) 1

When to Seek Medical Attention

• Signs that warrant immediate medical evaluation include 2:
  • Saturating a pad within an hour or less 2
  • Passing large clots (larger than a plum) 2
  • Bleeding that increases rather than decreases 1
  • Bleeding accompanied by fever, severe abdominal pain, or foul odor 2

Risk Factors for Prolonged or Excessive Bleeding

• Factors that may increase the risk of prolonged or excessive bleeding include 1, 2:
  • Uterine atony (most common cause of PPH) 1
  • Retained placental fragments 1
  • Cesarean delivery 1
  • Large blood loss during delivery 1
  • Infection 1

Physiological Changes During the Postpartum Period

• The body remains in a hypercoagulable state for approximately 3 weeks after delivery 3
• Elevated thrombotic risk persists for up to 12 weeks postpartum, with the highest risk in the first 6 weeks 4
• Platelet counts remain significantly elevated until around day 19 postpartum 3
• Fibrinogen levels remain elevated until approximately day 15 after delivery 3

Conclusion

While some spotting may persist beyond 6 weeks in some women, bleeding that continues beyond this timeframe or suddenly increases in volume should be evaluated by a healthcare provider as it may indicate complications requiring treatment 1, 2.