Differential Diagnosis for Postpartum Stink

Single Most Likely Diagnosis

• Postpartum lochia: This is the most common cause of a strong odor after childbirth. Lochia is the vaginal discharge that occurs after delivery, consisting of blood, tissue, and bacteria. It typically has a strong, earthy smell and can last for several weeks.

Other Likely Diagnoses

• Vaginal infection (e.g., bacterial vaginosis or trichomoniasis): These infections can cause a strong, unpleasant odor, especially if left untreated. They are common in the postpartum period due to hormonal changes and the introduction of bacteria during delivery.
• Perineal wound infection: If the perineum was torn or cut during delivery, an infection can develop, leading to a foul odor.
• Urinary tract infection (UTI): UTIs are common in the postpartum period and can cause a strong, unpleasant smell in the urine.

Do Not Miss Diagnoses

• Endometritis: This is an infection of the uterus that can occur after childbirth. It is a serious condition that requires prompt treatment with antibiotics. Symptoms include fever, abdominal pain, and a foul-smelling discharge.
• Septic pelvic thrombophlebitis: This is a rare but life-threatening condition where a blood clot in the pelvic area becomes infected. It can cause a foul odor, fever, and abdominal pain.

Rare Diagnoses

• Genital tract fistula: A fistula is an abnormal connection between two body parts, such as between the vagina and rectum. It can cause a constant, foul-smelling discharge.
• Retained placental tissue: If some of the placenta is not expelled during delivery, it can become infected and cause a foul odor. This is a rare complication of childbirth.