What is the usual time frame and changes of lochia (postpartum vaginal discharge)?

Lochia: Normal Duration and Characteristics in the Postpartum Period

Lochia typically lasts for approximately 4-6 weeks postpartum, progressing through three distinct phases: lochia rubra (red), lochia serosa (pink/brown), and lochia alba (white/yellow). 1, 2

Normal Duration of Lochia

• The median total duration of lochia is 27-36 days (approximately 4-5 weeks), with significant variation among women 1, 3
• Some women (approximately 13%) may experience lochia for up to 60 days postpartum 2
• Women with inherited bleeding disorders tend to have longer lochia duration (median 39 days) compared to women without bleeding disorders (median 31 days) 4

Phases of Lochia

Lochia Rubra

• First phase consisting of bright red blood with small clots
• Typically lasts for the first 3-5 days postpartum 2
• Contains erythrocytes, decidua, trophoblasts, lanugo, and vernix 1

Lochia Serosa

• Second phase with pinkish-brown discharge
• Usually occurs from days 5-14 postpartum but can last longer (median 22 days) 2
• Contains serous exudate, erythrocytes, leukocytes, cervical mucus, and microorganisms 1

Lochia Alba

• Final phase with yellowish-white discharge
• Begins around 2-3 weeks postpartum and continues until cessation 1
• Contains leukocytes, decidua, epithelial cells, fat, cervical mucus, and bacteria 1

Patterns of Lochia

Research has identified three distinct patterns of lochia 1:

• Type 1 (Most common): Classic progression from rubra→serosa→alba (51% of women)

  • Associated with breastfeeding
  • Rubra phase lasts approximately 12 days 1

• Type 2: Extended rubra phase with shorter serosa and alba phases (28% of women)

  • Associated with higher parity and less breastfeeding
  • Rubra phase lasts approximately 25 days 1

• Type 3: Two distinct rubra phases separated by serosa/alba phases (21% of women)

  • May be a variant of type 2 1

Factors Affecting Lochia

• Breastfeeding: More women with the classic type 1 pattern are breastfeeding compared to those with type 2 pattern 1
• Parity: Multiparous women tend to have shorter overall lochia duration 2
• Labor duration: Longer labor is associated with heavier lochia 4
• Mode of delivery: Instrumental deliveries are associated with heavier lochia 4
• Infant birth weight: Women with smaller babies tend to have shorter lochia duration 2

Important Considerations

• Approximately 20% of women experience an "end-of-puerperium" bleeding episode around day 40 postpartum 3
• About 11% of women may experience a bleeding episode within 56 days postpartum that is separate from lochia (separated by at least 14 bleeding-free days) 3
• The traditional teaching that lochia lasts only 2 weeks is inaccurate; the median duration is closer to 4-5 weeks 1, 5

Warning Signs Requiring Medical Attention

• Sudden heavy bleeding or passing large clots after lochia has lightened 6
• Foul-smelling discharge, which may indicate infection (postpartum endometritis) 6
• Fever >100.4°F (38.0°C) on more than two occasions >6 hours apart 7, 6
• Severe abdominal pain or uterine tenderness 6
• Lochia that persists beyond 8 weeks without changing color or decreasing in amount 1, 2

Understanding the normal progression and duration of lochia helps differentiate physiological postpartum bleeding from pathological conditions requiring medical intervention.