After surgical delivery, as well as after the usual, a woman has discharge from the genitals. By their nature, much can be said about how the recovery process is going after the operation in a particular patient. Postpartum discharge (lochia) can both indicate that everything is in order with the new mother, or be a signal of complications. In this article, we will look at the different types of discharge after surgical delivery and tell you when they should be completed.
Causes
Both after natural childbirth and after cesarean section, discharge from the genitals indicates the process of reverse development of the uterus. Involution begins immediately after surgeons remove the baby and placenta from the mother's womb and suture.
From the moment the two cherished strips were found on the express test and until the day of the delivery operation, the female reproductive organ increases 500 times. The smooth muscles of the uterus stretch, the ligaments lengthen and coarse. The placenta, which nourishes the child and supplies him with the oxygen necessary for life and development, grows firmly with a network of blood vessels into the wall of the uterus.
Bloody discharge after physiological childbirth is due only to the separation of the placenta and the violation of this "joint" vascular network. After a cesarean section, the injury is more significant: in order to penetrate into the uterine cavity, you have to make an incision on its wall. This also injures the blood vessels of the reproductive organ. Together with bleeding after placenta separation lochia becomes more abundant and more intense after surgical delivery.
The uterus itself cannot shrink immediately after the baby is removed. It remains large for some time, however, now it looks more like an empty bag from which all the contents have been taken out. It will decrease almost to its original size, but the process of involution takes time.
Involution will be accompanied by spasms that resemble contractions in nature. They are called uterine contractions. Contractions after cesarean are not as active as after physiological childbirth, and therefore a woman is obliged to receive injections of reducing drugs on a schedule. A few minutes after the introduction of "Oxytocin" or another drug based on it, the uterus begins to actively contract, which is accompanied by an increase in discharge from the genitals - you do not need to be afraid.
Both the woman herself and her doctor should be very attentive to the nature of lochia both at an early stage after the operation and after being discharged home. In order to figure out whether there are grounds for concern, you need to know what kind of discharge after surgical delivery should be normal.
What should be?
Abundant bleeding for the first days after surgery is an absolute norm. Blood is released from the damaged bloodstream at the placenta attachment site, as well as from the wound in the incision area in the uterus. By the end of the first day, the internal wound begins to tighten, and fibrin threads help it, which cover the wound surface and prevent a large loss of blood. This mechanism is natural, natural, it is impossible to influence it.
Therefore, in the first hours after the operation, the discharge is scarlet, red, and after 10-12 hours, blood clots can be detected in them (the work of fibrinogen). The presence of clots of different sizes and numbers either on the second or on the third day after the operation should not embarrass the mother. Their exit, on the contrary, is considered a favorable sign - the uterus involutions.
If a laboratory smear test is done during this period, a high number of red blood cells in vaginal discharge will be the absolute norm.
By the time of discharge from the hospital (and after the operation today they are discharged on the fifth day), the lochia usually changes somewhat. They are still bloody, but the serum content increases. A significant amount of mucous ichor begins to be determined on the sanitary napkin. There should be no blood clots at this stage.
A laboratory examination of a smear these days shows the presence of an impressive number of leukocytes and epithelial cells, which are dead myocytes - cells of the uterus that were damaged when its wall was cut with a scalpel.
Even more mucus in the discharge normally appears a week after the operation. This is cervical mucus, which begins to be produced in large quantities. Often at this stage, women are frightened when they find small brown fragments on the gasket that resemble worms. There is no reason to worry: these fragments are the ends of surgical self-absorbable sutures, which were used to apply an internal suture. This does not mean that the seam diverges. - just particles of threads that did not directly enter the tissues of the uterus fall off and are removed by the body outside. The more difficult the inner seam was (two-row, three-row), the more brown fragments can be detected in the cervical mucus.
The color and consistency of the discharge will change almost every day. After a month, the lochia will become more scarce. Moderate, uniform, pinkish or yellow discharge may persist for up to a month and a half after surgery. By 7–8 weeks, they become normal, as they should have been and were before pregnancy.
The bleeding ends by 6-7 weeks, but doctors recommend waiting a couple more weeks after the lochia has stopped before engaging in sexual activity.
It is difficult to calculate the total amount of blood loss during the period of postpartum discharge. According to some reports, it exceeds one and a half kilograms of net weight based on body weight, taking into account the contraction of the uterus when it ends.
Recommendations
The earlier a woman gets out of bed, the better the blood clots will come out and the reproductive organ will contract. That is why it is recommended to get up and move (without too much fanaticism, of course) within 10-12 hours after the operation. Early attachment of the baby to the breast is also an additional favorable moment, because during breastfeeding, the amount of oxytocin in the body increases, the uterus begins to contract more actively.
In the first three days after surgery it is important to prevent wound infection and vaginal ascending infection. That is why women are urged to use only hospital liners that are sterile. They need to be changed every three hours. From the moment a woman learns to walk, she can wash herself 2-3 times a day, washing the external genitals and completely excluding the ingress of water into the vagina. It is strictly forbidden to use factory sanitary napkins at this stage.
On the fifth day after the operation, you can use any pads, the main thing is not to forget to change them more often. A woman can switch to daily hygienic thin pads immediately after the bleeding stops.
In addition to controlling the color, amount and consistency of vaginal discharge, both in the hospital and at home after discharge, it is important to measure body temperature - this is an important sign of the state of the postpartum woman. Quite often, it is its sharp increase, long-term nature that act as the first signs of the onset of inflammation (discharge of the corresponding character will appear a little later).
Do not hesitate to ask questions of the medical staff of the maternity hospital. Lochia and their character after operational delivery is a very important topic, and therefore there should not be anything unsaid in it. Also, you do not need to hide from the doctor any deviations of the discharge from the above-described norm. The fear that discharge may be delayed makes women sometimes reckless.
It won't be possible to hide the complications that have begun for a long time. And even if this can be done before discharge, then after it, after a few days, the woman may again be in the hospital, but this time without a child, since with postpartum complications, they are hospitalized in gynecological departments.
Deviations from the norm
Pathological discharge most often speaks of complications of surgery or exacerbation of chronic diseases in a puerpera. The likelihood of complications always exists. No clinic, even if the operation is done for a fee, can never guarantee that everything will go smoothly.
During the operation, abnormal situations may arise in which, for example, a vascular node will be injured, and also in the very early postoperative period, bleeding from the genitals will be profuse, massive, incessant. The absence of discharge or very poor discharge in the first three days may indicate hypotension or atony of the uterus, when it does not contract or it occurs extremely sluggishly and slowly. In this case, blood clots may also not be observed.
Pathogens can enter the uterine cavity even in a sterile operating room, infection can also occur in the postoperative period, and then internal inflammation will begin, which will necessarily manifest itself by a change in the nature of discharge, high temperature, and deterioration of well-being in general.
While the woman is in the hospital, doctors will be able to pay attention to changes in her condition. But after being discharged home, control over secretions should not weaken in the least. In all cases, you need to see a doctor - self-medication in this matter is unacceptable. Common pathological situations are:
- severe bleeding opened after the discharge temporarily stopped;
- blood discharge with clots began after being discharged home;
- the temperature has risen against the background of any discharge;
- there is little discharge in the first days or their earlier termination (a week after the operation);
- a liquid of a strange color with an unpleasant odor is released;
- lochia are protracted: discharge continues 2 months after cesarean section;
- there are impurities in the secretions, flakes, light clots;
- I have a stomachache;
- purulent, green, gray discharge with a pungent unpleasant odor appeared;
- there is a bloody or other discharge from the suture on the abdominal wall after discharge.
Pathological discharge does not go away by itself, so you should not count on it.
What do they mean?
What certain deviations in the nature of the discharge can talk about, only a doctor who will prescribe an examination and take tests from a newly-made mom can answer for sure. But a few common problems will be described on an introductory basis.
- Pink mucous membranes. This character of lochia is the norm for 5-15 days after the operation, but after a month or two it is a sign of slow healing of the internal scar. It is possible that a woman's body rejects surgical suture material at the immune level. Also, such discharge can occur in women who, contrary to the doctor's recommendations, began their sexual activity early, without waiting for the end of the lochia and the healing of the internal scar. If such a discharge is found, a doctor's consultation, a smear and an ultrasound of the inner seam are required.
- Yellow-green. Discharge with endometritis and any other starting inflammatory process has such a character. Usually they have an unpleasant fishy odor, itching and burning in the perineal region, abdominal pain, high fever can be observed. The woman is urgently shown hospitalization and a long course of treatment.
- Watery. Such discharge is also a rather alarming sign. They can talk about impaired circulation in the uterus. A watery consistency in this case is a sign of transudate discharge. If watery lochia without a special color or slightly yellowish are accompanied by an unpleasant odor, in no case should you postpone a visit to the doctor.
- Thick white. They can be a sign of vaginal dysbiosis, as well as a sign of thrush, if accompanied by itching and burning. After the operation, a woman's immunity weakens significantly, and the manifestation of thrush may well take place. Do not self-medicate: many vaginal products that were used even during pregnancy can harm after surgery until the scarring of the internal uterine scar is completed. Therefore, it is best to consult a doctor.
Memo for the postpartum woman
Of course, I would like the discharge after cesarean to be short and not overshadow the happiness of motherhood, but they are inevitable, and you need to get used to this thought. It is important not only to control the nature of the discharge, but also to do everything possible to reduce the likelihood of possible complications.
Don't lift weights
If you want the internal scar to be formed well-off and allow you to have more children, as well as in order to eliminate the likelihood of its rupture, discrepancy, tear, you need to understand that weight lifting is categorically contraindicated. Moreover, on the first day, it is better to limit the weight of a bowl of soup in general, and after discharge the maximum weight for manual lifting should not exceed 4 kilograms.
The limitation should be taken for granted after the release of lochia is complete. So, for at least six months, a woman can neither swing the press, nor squat, nor jump. Carrying heavy bags or a stroller up the stairs is out of the question.
Don't rush to have sex
You can return to sexual pleasures after a cesarean section only after the postpartum discharge from the genitals is completely completed and the primary healing of the inner suture takes place. The limitation period is 2 months. If the discharge does not stop during this period, you need to consult a doctor and postpone your intimate life for some more time, which the specialist will indicate.
Early sex is fraught with the development of infection, because the penis, even with a condom, is not a model of sterility. Opportunistic microorganisms and pathogens can easily enter the genital tract and cause serious inflammation of the reproductive system organs or the area of the wound.
Intense (and even non-intense) frictions can cause mechanical damage to the internal scar, and orgasm and sexual arousal increase blood flow to the smooth muscles of the uterus, which can cause the formation of an incompetent internal scar, increased blood discharge, and the formation of a keloid scar.
Monitor your menstrual cycle
Contraception plays an important role in preventing complications. After the discharge stops, the couple must use condoms. After 2-7 months, menstruation is usually established, after which you can choose, together with the doctor, any of the existing methods of contraception - it is strongly not recommended to get pregnant again within 2 years.
It is necessary to monitor the vaginal secretion even after the end of the lochia. It is possible that menstruation will begin in a few days or weeks after that. They will be almost the same as they were before the onset of pregnancy, except that there will be fewer clots in the menstrual flow, since the endometrium has not yet fully recovered.It is possible that the first menstruation will be more scarce than usual, their short duration will also be considered normal - not six days, as before, but only 3-4 days.
Gradually, menstruation will return to normal. Neither their duration, nor the nature, nor the frequency of the caesarean section can totally affect. Within six months, the cycle will be restored and will return to the previous one.
Don't use tampons
Until the lochia has stopped, it is strictly forbidden to use tampons instead of sanitary pads. With a tampon there is no free release of vaginal secretions outside, and such "stagnation" can cause a serious inflammatory process.
Douching in the first six months, inserting vaginal suppositories (except for those recommended by a doctor) and injecting vaginal creams are also contraindicated.
Reviews
The average duration of discharge after cesarean, according to reviews, is almost the same as after natural childbirth. But their color and smell are important, which experienced mothers do not advise to ignore.
For information on how the postpartum period should go, see the next video.
