From the Guidelines
Vaginal bleeding after childbirth with an episiotomy typically lasts about 4-6 weeks, though the heaviest bleeding occurs in the first 1-2 weeks. This postpartum bleeding, called lochia, will gradually change from bright red (lochia rubra) in the first few days to pinkish-brown (lochia serosa) after about a week, and finally to yellowish-white (lochia alba) before stopping completely 1. The episiotomy site itself may cause some additional localized bleeding initially but should not significantly extend the duration of normal postpartum bleeding.
Key Points to Consider
- The most common cause of early postpartum hemorrhage (PPH) is related to uterine atony, which is typically a clinical diagnosis in >75% of patients 1.
- Late or delayed PPH occurs between 24 hours and 6 weeks postpartum, with common etiologies including retained products of conception (RPOC), subinvolution of the placental bed, or infection 1.
- To manage discomfort and promote healing, it is recommended to:
- Use ice packs for the first 24 hours
- Take prescribed pain medication as directed
- Practice proper perineal hygiene by gently cleaning the area with warm water after using the bathroom
- Change sanitary pads frequently
- Perform sitz baths 2-3 times daily
- Contact your healthcare provider if you experience heavy bleeding that soaks through more than one pad per hour, pass large clots (larger than a plum), notice foul-smelling discharge, develop a fever, or experience increasing pain in the episiotomy area, as these could indicate infection or complications requiring medical attention.
Important Considerations for Healthcare Providers
- Pelvic ultrasound (transabdominal and transvaginal with Doppler) is the imaging modality of choice for the initial evaluation of PPH 1.
- Contrast-enhanced CT of the abdomen and pelvis and CT angiogram of the abdomen and pelvis may be appropriate to determine if active ongoing hemorrhage is present, to localize the bleeding, and to identify the source of bleeding 1.
From the Research
Postpartum Vaginal Bleeding after Episiotomy
- The expected duration of postpartum vaginal bleeding after an episiotomy is not explicitly stated in the provided studies 2, 3, 4, 5, 6.
- However, the studies discuss various complications associated with episiotomy, such as hemorrhage, perineal tears, infections, and vaginal hematoma, which can affect the duration and severity of postpartum bleeding 2, 3, 4.
- The management of these complications, including conservative therapy, surgical management, and selective arterial embolization, is also discussed in the studies 2, 3, 5, 6.
- It is recommended that women who have undergone an episiotomy should be closely monitored for signs of complications, such as excessive bleeding, and receive appropriate management and care 5.
- The studies also highlight the importance of considering the risk factors for bleeding, such as primiparity and manual removal, in women who have undergone an episiotomy 4.
- In general, postpartum bleeding can last for several weeks, but the exact duration can vary depending on individual factors and the presence of any complications 5.