Lochia Research Articles

Postpartum uterine involution promoted by penetrating-moxibustion therapy: a randomized controlled trial.

To observe the effect of penetrating-moxibustion therapy on postpartum uterine involution. Eighty puerpera were randomized into an observation group and a control group, 40 cases in each one. In the control group, oxytocin injection was administered by intravenous drip, 20 U each time, once daily. In the observation group, on the base of the treatment as the control group, the penetrating-moxibustion therapy was used at Shenque (GV 8), Qihai (CV 6) and Guanyuan (CV 4), 30 min to 40 min each time, twice a day. The intervention of each group started from the first day after childbirth and lasted 3 days. The uterine volume before and after treatment, and in 42 days of postpartum, the height decrease of the fundus of the uterus, the score of visual analogue scale (VAS) for uterine contraction, the volume of lochia rubra in 1 to 3 days of treatment, and lochia duration were compared between the two groups; and the clinical effect was evaluated. The uterine volume in the observation group was smaller than that of the control group after treatment (P<0.01). In 1 to 3 days of treatment, the height decrease of the fundus of the uterus in the observation group was larger (P<0.01), VAS scores of uterine contraction were lower (P<0.05, P<0.01), the lochia rubra volume was less (P<0.01) than those in the control group. The duration of lochia rubra and lochia was shorter (P<0.01) in the observation group when compared with that of the control group. The favorable rate of uterine involution in the observation group was 95.0% (38/40), higher than that of the control group (75.0%, 30/40, P<0.05). Penetrating-moxibustion therapy accelerates the recovery of the uterine volume, relieves uterine contraction, shortens the duration of lochia, reduces the lochia volume and promotes the postpartum uterine involution.

ASUHAN KEPERAWATAN IBU NIFAS PADA NY F POST SECTIO CAESAREA DI RUANG TERATAI RSUD BATARA SIANG PANGKEP

Sectio Caesarea is a medical action that is needed to help deliveries that cannot be carried out normally due to problems with the mother's health or the condition of the fetus, this problem can be overcome by the role of nurses in providing comprehensive nursing care. The purpose of this study is to be able to carry out nursing care for postpartum mothers with post-sectio caesarean section at Batara Siang Pangkep Hospital.The research method is a qualitative method with a case study approach.The results of the study were obtained in patients with post section caesarea pathological indications that need to be considered is the assessment on physical examination, namely breast enlargement, uterine contractions are good/hard, there is lochia rubra. some changes in physical, psychological and social problems. The nursing problems found in the case review were acute pain, knowledge deficit, risk of infection.the intervention still refers to the target, outcome criteria and time criteria. At the end of the evaluation all objectives can be achieved due to good cooperation between the patient, family and health team, suggestions the involvement of the patient, family and health team that is well established needs to be improved so that mutual trust arises

Effects of Cognitive Nursing Combined with Continuous Nursing on Postpartum Mental State and Rehabilitation.

Purpose This study is aimed at exploring the effects of cognitive nursing combined with continuous nursing on postpartum mental state and rehabilitation. Methods Totally, 124 puerperas admitted to our hospital from January 2019 to January 2020 were selected and divided into a research group and a control group according to different nursing methods, with 62 cases in each group. The control group received routine care, while the research group received cognitive nursing combined with continuous nursing on this basis. The mental state, rehabilitation indicators, quality of life, incidence of complications, and nursing satisfaction were compared between the two groups after intervention. Results Before nursing, there was no statistically significant difference in the SAS and SDS scores between the two groups (P > 0.05); after intervention, the SAS and SDS scores of the two groups were significantly reduced, and those of the research group were lower than those of the control group (P < 0.05). After intervention, the time of the first breastfeeding, duration of lochia rubra, length of hospital stay, and score of uterine contraction pain of the research group were lower than those of the control group (P < 0.05); the psychological function, physical function, material life, and social function scores of the research group were higher than those of the control group (P < 0.05); the incidence of complications in the research group was 4.84%, lower than 20.97% in the control group (P < 0.05); the nursing satisfaction of the research group was 96.77%, which was significantly higher than 83.87% in the control group (P < 0.05). Conclusions Cognitive nursing combined with continuous nursing can effectively improve the mental state, shorten the length of hospital stay, increase the perceived well-being, and promote the physical rehabilitation in puerperas, which is worth promoting in clinical practice.

Clinical effect of ergometrine maleate injection combined with posterior pituitary injection in the treatment of postpartum hemorrhage

Objective To investigate the clinical effect of ergometrine maleate injection combined with posterior pituitary injection in the treatment of postpartum hemorrhage. Methods From April 2016 to July 2018, 68 patients with postpartum hemorrhage treated in the Maternal and Child Health Care Hospital of Tongxiang were randomly divided into two groups according to the random number table, with 34 patients in each group.The control group was treated with posterior pituitary injection.The observation group was treated with ergometrine maleate injection combined with posterior pituitary injection.The bleeding volume at different time points after treatment was compared between the two groups.The hemostasis time, the duration of uterine contraction, the extent of uterine decline, the duration of lochia and serum cytokines levels before and after treatment were compared. Results The bleeding amount at 0.5 h, 2 h, 24 h after administration in the observation group were (76.82±15.40) mL, (112.34±18.73) mL and (196.70±20.60) mL, respectively, which were significantly lower than those in the control group[(147.38±17.65), (198.49±19.37) mL, (283.74±21.56) mL](t=17.565, 18.643, 17.020, all P<0.05). The duration of contractions[(3.83±1.40) h] and the extent of uterine decline[(6.25±0.93) cm] in the observation group were significantly better than those in the control group[(1.92±0.59) h, (4.65±0.66) cm], and the hemostasis time[(21.29±3.60)min] and duration of lochia[(17.19±4.67)d] in the observation group were significantly shorter than those in the control group[(42.28±3.85) min, (24.28±6.11) d](t=23.220, 7.331, 8.181, 5.376, all P<0.05). After treatment, the levels of nitrogen monoxide (NO)[(91.22±6.23) μmol/L], nitric oxide synthase (NOS)[(24.56±2.46) μmol/L], brain natriuretic peptide (BNP)[(46.81±5.10)ng/L] in the observation group were lower than those in the control group[(98.63±7.51) μmol/L, (30.92±3.95) μmol/L, (90.35±4.66)ng/L], and the differences were statistically significant (t=4.428, 7.969, 36.750, all P<0.05). Conclusion The effect of ergometrine maleate injection combined with posterior pituitary injection on postpartum hemorrhage is effective, which can effectively control the amount of bleeding, shorten the time of hemostasis and promote postpartum recovery. Key words: Postpartum hemorrhage; Ergonovine; Vasotocin; Drug therapy, combination; Nitric oxide; Nitric oxide synthase; Natriuretic peptide, brain

Efficacy of different doses of flurbiprofen axetil on post-cesarean analgesia with butorphanol

Objective To study the analgesic effect of different doses of flurbiprofen axetil on post-cesarean analgesia with butorphanol. Methods Three hundreds patients undergoing elective cesarean section were randomly allocated into three group by random number table (n=100). After fetus delivery, three groups were all received patient controlled intravenous analgesia (PCIA) with butorphanol 12 mg diluted by normal saline (NS) into 100 ml (background infusion 2 ml/h, patient control analgesia (PCA) 2 ml, lockout interval 15 min). After the baby was removed, 50 mg and 100 mg flurbiprofen axetil were slowly injected intravenously in group Ⅱ and group Ⅲ, respectively. The Visual Analogue Scale(VAS) scores of incision pain, Ramesay sedation score, total PCA times and the degree of satisfaction about post-operative analgesia were measured at 4, 8, 12 h and 24 h after surgery respectively. Weight of lochia 6 h after surgery and the time of milk secretion were recorded. Other side effects such as hypoxemia, nausea, vomiting including neonatal complications were also recorded. Results There were no statistical differences in demographics among three groups. The data of all patients were collected and no patient needed extra analgesia. Compared with group Ⅰ, the VAS scores and the consumption of butorphanol of 4, 8, 12, 24 h were lower in the group Ⅱ and group Ⅲ, while the degree of satisfaction was higher(P 0.05). There were no statistical differences in Ramsay sedation scores (P>0.05). Conclusions Flurbiprofen axetil could provide better analgesic effect on post-cesarean analgesia with butorphanol (100 mg was superior to 50 mg). Furthermore, it did not influence uterine contraction or the time of milk secretion. Key words: Flurbiprofen axetil; Butorphanol; Cesarean section; Analgesia

Postplacental insertion of IUCD Cu T 380A at transcesarean section does not influence bleeding and infection at puerperial period

Objective: To determine the difference of the puerperial bleeding and puerperial infection women who had intrauterine contraceptive device (IUCD) T380A insertion at caesarean section compare with women who had caesarean section without IUCD insertion.Materials and Methods: This study was an observasional analytic prospective cohort. Participants allocated to 2 groups : IUCD inserted during cesarean and cesarean with no device inserted. Subject research monitoring at 10 and 40 day of puerperial period.Results: Puerperial bleeding of group with IUCD insertion is 99,309+32,845 ml and group without IUCD is 88,010+30,824 ml, with the analysis test got p=0,085 (p&gt;0,05) means no difference between two groups.Level hemoglobin at post cesarean section (day-0), 10 and 40 day, proportion increasing severity of anemia and duration of lochia rubra were analized and got p&gt;0,05, no difference between two groups. Duration of puerperial bleeding period, median group with IUCD 40 days (25-50) and group without IUCD 30 days (26-45), with analized test got p&lt;0,05. Duration of puerperial bleeding were significantly difference. Proportion of clinical sign puerperial infection 3 (6,4%) of group with IUCD and 2 (4,1%) of group without IUCD, with analized test got p=0,614 (p&gt;0,05), no difference between two groups. Level of leucocyte at post cesarean section (day-0), 10 and 40 day, the difference both two groups was not significant (p&gt;0,05). In this research the difference puerperial bleeding and proportion puerperial infection between two groups (women who had IUCD T380A insertion at caesarean section compare with women who had caesarean section without IUCD insertion) was no significant.Conclusion: Insertion IUCD Cu T 380A postplacental at caesarean section is safety.

Effects of self-made traditional Chinese medicine concentrate for sponge bath and feet bath on postpartum recovery in parturients with cesarean section

Objective To explore the effects of self-made traditional Chinese medicine (TCM) concentrate for sponge bath and feet bath on postpartum recovery in parturients with cesarean section. Methods A total of 300 parturients with cesarean section were selected as subjects from July 2014 to December 2015 and were randomly divided into three groups including group A (100 cases, sponge bath and feet bath with TCM), group B (100 cases, feet bath with warm water), group C (100 cases, without intervention) with informed consent according to bed numbers. We observed the volume of lochia, height of fundus, the time of first flatus, milk yield, sleep quality, length of stay among groups after childbirth. And then, we explored the effects of self-made TCM concentrate for sponge bath and feet bath on postpartum recovery in parturients with cesarean section by comparing indicators among groups. Results The volume of lochia, height of fundus, the time of first flatus, milk yield, sleep quality in group A were better than those in group B and C with significant differences (P<0.05) along with the length of stay in group A 0.5-1 d less than that in group B and C. Conclusions The self-made TCM concentrate for sponge bath and feet bath can reduce the length of stay and contribute to reducing the volume of lochia post partum, promoting the involution of uterus and intestinal peristalsis, increasing the milk yield, improving sleep quality, relieve postoperative pain so as to promote postpartum recovery. Key words: Cesarean section; Postpartum recovery; Foot bath; Sponge bath; Traditional Chinese medicine concentrate

Efficiency of ring butterfly sewing in lower uterine segment aided with tourniquet in treating pernicious placenta previa combined with placenta percreta

Objective To investigate the efficiency of ring butterfly sewing in lower uterine segment aided with tourniquet in treating pernicious placenta previa combined with placenta percreta. Methods Twelve pregnant women diagnosed with pernicious placenta previa combined with placenta percreta by prenatal ultrasound in Peking University First Hospital from April 1, 2012 to November 30, 2014, were enrolled. All of them received elective cesarean delivery using ring butterfly sewing in lower uterine segment aided with tourniquet. The efficiency of this novel technique, in term of blood loss and vital signs during operation, blood transfusion, and postoperative recovery, was analyzed. Results Twelve cases were diagnosed with placenta percreta during operation, with placenta invading the perimetrium in seven cases and urinary bladder being involved in one case. Ring butterfly sewing in lower uterine segment aided with tourniquet during elective cesarean delivery was all successful in the 12 cases. The median amount of blood loss was 1 000(400-2 000) ml during operation and the amount of blood loss was lower than 1 000 ml in three cases. Two cases received no blood transfusion, and the median blood transfusion in the other 10 cases were 400(400-1 200) ml. The mean operation time was (75±22) min (43-131) min. Eleven cases had normal lochia and temperature after operation and the other one had placenta invading urinary bladder and partial placenta in situ, and developed fever at day 3 after operation, but recovered after antibiotic treatment, and no placenta tissue was seen by ultrasound at day 59 after operation. Conclusions The ring butterfly sewing in lower uterine segment aided with tourniquet is highly effective for the pernicious placenta previa combined with placenta percreta, and it is a simple, fast and fertility sparing technique with low blood loss and without usage of special equipment. Key words: Placenta previa; Placenta percreta; Tourniquets; Ligation; Suture techniques; Gynecologic surgical procedures

Comparison of the clinical effect of different delivery mode of the re-pregnancy after cesarean section

Objective To observe and research the influence of vaginal delivery and cesarean section by two kinds of mode of delivery on maternal infant outcome of re-pregnancy after cesarean section. Methods 258 patients with re-pregnancy after cesarean section were selected,they were divided into vaginal delivery group(73 cases)and cesarean section group(185 cases)according to the different delivery mode.The maternal puerperal infection rate,24h postpartum hemorrhage volume,days,cost of hospitalization,lochia time and neonatal in hospital of both two groups were compared. Results The success rate of vaginal delivery was 69.52%, the rate of cesarean section was 71.71%.In vaginal delivery group,maternal puerperal infection rate,24 h postpartum hemorrhage volume,length of hospital stay,cost of hospitalization,lochia time were 1.73%,(201.54± 107.54)m L,(3.41±0.09)d,(1 540.12±117.21),(21.36±13.12)d,which were significantly better than the second cesarean section group[8.11%,(354.64±215.54)m L,(7.45±0.32)d,(4 932.62±786.35),(27.11± 17.04)d],the differences were statistically significant(χ2= 4.08,t= 4.75,7.24,8.91,3.98,all P 0.05). Conclusion Re-pregnancy after cesarean section is not the choice of cesarean section delivery clinical indications of operation,when the pregnant women with indications of trial production,in strict monitoring downlink vaginal delivery. Key words: Cesarean section; Subsequent pregnancy; Vaginal delivery; Surgical operation; Complications

The effects of early postnatal sucking and health education on maternal lactation and physical rehabilitation

Objective To explore the application effect of postpartum early sucking and health education in the postpartum nurs- ing. Methods From December 2013 to December 2014 in our hospital 80 cases of primipara for delivery were randomly divided into observa- tion group and control group with 40 cases in each group. The control group received routine nursing, the observation group adopted early postpartum sucking and the health education based on the control group, the comprehensive indexs assessment were used to evaluate nursing effects of the two groups. Results The knowledge of maternal and infant health care knowledge, nursing ability in the observation group were higher than those in the control group, the initial time of lactation time was less than that in the control group, amount of lactation was more than that in the control group, with statistical significance （P 〈 0. 05） . Postpartum uterine into the pelvis, lochia time, complications, hospitalization time in the observation group were less than those in the control group, the anxiety, depression score were lower than those in the control group, the scores of life quality in all aspects were higher than those in the control group, with statistical significance （P 〈 0.05 ） . Conclusions Early postpartum sucking and health education are advantageous to promoting lactation maternal, improving self - care ability and promoting physical rehabilitation. Key words: Early postnatal sucking ; Health education ; Primipara ; Lactation; Physical rehabilitation

Application of nursing supervision in postpartum visit in community

Objective To analyze the effect of applying nursing supervision in postpartum visit in the community.Methods 600 puerperae were collected from the community from May,2010 to May,2010.All of them received postpartum visit and nursing supervision.The command degrees of the knowledge and skills were analyzed before and after the supervision.Results After the nursing supervision,lochia observation(83.67％),breastfeeding(86.17％),maternal body care(88.17％),physical training(90.83％),postpartum nutrition(77.17％),bathing(88.00％),touching(79.83) etc.of the puerperae were significantly better than that before the supervision,with statistical differences(P ＜ 0.05).Conclusions Application of nursing supervision in postpartum visit can timely solve the problems caused by maternal care after discharge,provide the puerperae with continuous nursing care,and improve their life quality. Key words: Nursing supervision; Community; Postpartum; Bisit

Analysis of the result about 3960 postpartum cases from health examination

Objective To study the recovery from postpartum women, analyze existing problems and make recommendations. Methods Retrospective analysis of the health-care examination of 3960 postpartum women from January 2008 to December 2009. Results 73.84% puerpera persisted in breast-feeding and the breast-feeding rate of vaginal delivery were higher than the cesarean section.The extended lochia rat in vaginal delivery were 6.95% but in the cesarean section were 9.44%,the difference between them was notable. P<0.05.Apart from that, there were significant differences in the rate of first menses according to age, parity and mode of delivery and the rate of extended lochia in the mode of delivery, and a few puerpera with hypertension in pregnant period had left hypertension. Conclusions Spontaneous delivery and breast-feeding can help puerpera recover successfully. It is necessary to publicize health-care knowledge during circumnatal period,improve the understanding of self-health awareness and take effective measures to birth control. Key words: Health examination of postpartum; Analysis

The effect of health and nutrition education intervention on women's postpartum beliefs and practices: a randomized controlled trial.

Background'Sitting month' is the Chinese tradition for postpartum customs. Available studies indicate that some of the traditional postpartum practices are potentially harmful for women's health. However, no intervention study aiming at postpartum practices has been performed. In this paper we evaluated the effect of a health and nutrition education intervention, which focused on improving postpartum dietary quality and optimal health behaviors.MethodsThe study design was a randomized controlled trial conducted in both urban and rural area of Hubei between August 2003 and June 2004. A total of 302 women who attended the antenatal clinic during the third trimester with an uncomplicated pregnancy were recruited. Women randomized to the education intervention group in both urban and rural area received two two-hour prenatal education sessions and four postpartum counseling visits. Control group women received usual health care during pregnancy and postpartum period. Women were followed up until 42 days postpartum. Outcome measures were nutrition and health knowledge, dietary behavior, health behavior and health problems during the postpartum period.ResultsWomen in the intervention groups exhibited significantly greater improvement in overall dietary behaviors such as consumption of fruits, vegetables, soybean and soybean products as well as nutrition and health knowledge than those in the control groups. Significantly more women in the intervention groups give up the traditional behavior taboos. The incidence of constipation, leg cramp or joint pain and prolonged lochia rubra was significantly lower in the intervention groups as compared with the control groups.ConclusionThe study shows that health and nutrition education intervention enable the women take away some of the unhealthy traditional postpartum practices and decrease the prevalence of postpartum health problems. The intervention has potential for adaptation and development to large-scale implementation.Trial registration numberklACTRN12607000549426

Effect of misoprostol on gastrointestinal peristalsis after cesarean section

Objective To explore the effect of misoprustol on restoration of gastroinete stinal function after cesarean section.Methods 100 patients after cesarean section were randomly divided into two groups:50 patients were treated by dropping rectum with misoprostol 200μg.The other 50 patients were the control group.To compare the two groups of the time of wind breaking,the time of lactation and postpartum hemorrhage.Results The duration of there recovery time of the gastrointestinal functionin and lactation of misoprostol group was shorrer than that in the control group(P＜0.05).Quicker involution of uterus and less quantity of red lochia were compared with the control group(P＜0.05).Conclusion Misoprostol used after cesarean section can accelerate lactation and wind breaking and the involution of uterus.It would he used clinically for its safety,eonvenieney and without evident side effects. Key words: Misoprostol; Cesarean section; Peristalsis

Clinical study on patterns of postpartum lochia

目的 探讨产后恶露变化规律,绘制恶露变化模式图.方法2002年7月至12月在我院分娩的产妇,剖宫产191例,阴道分娩187例.用子宫出血记录表通过面积法记录格子型卫生巾上血染格子数,测量产后24 h后至恶露干净时的每日出血量及恶露持续天数.产妇统一于产后42 d回院随访,回收子宫出血记录表.结果恶露持续时间阴道分娩组为(33.9±12.0)d,剖宫产组(39.6±13.1)d;95%CI分别为10～57 d和14～65 d,差异有统计学意义(P＜0.05).剖宫产组波动性恶露病例(103例,66.5%)明显多于阴道分娩组(28例,19.9%,P＜0.01). 结论剖宫产组恶露时间长于阴道分娩组,95%CI为阴道分娩组10～57 d,剖宫产组14～65 d.产后恶露具有波动性,尤其是剖宫产组。

Labor Induction Using Titrated Oral Doses of Misoprostol in Pregnancy with Myoma

Objective: To avoid uterine hyperstimulation of misoprostol during labor induction, we adopted a new method of repeated smaller doses titrated and used orally in one pregnancy with myoma. In addition, we assessed the effectiveness and safety of this regimen. Case Report(s): A 29-year-old pregnant woman complained of lower abdominal pain at 21 weeks of gestation. At that time, a leiomyoma approximately 8.4 × 7.3 cm in the anterior wall of uterine lower segment was found on a sonogram. There were no abnormal findings except for uterine myoma and high-normal blood pressure without proteinuria and edema in all prenatal examinations. She was admitted to the delivery room for labor induction at 39 weeks of gestation due to grade Ill calcified placenta and oligohydramnios. The principle of the labor induction with misoprostol was according to the titrated oral method. The Bishop score was 3 before labor induction and total dose of misoprostol used was 250μg. No hyperstimulation or no fetal distress was found during the whole labor course. The induction to active phase interval was 14 hours and 45 minutes, while the induction to vaginal delivery interval was 16 hours and 20 minutes. A male newborn that weighed 3050 g was delivered vaginally and the Apgar’s score of 1’/5’ was 9/10. Three tablets of oral misoprostol (600μg) were given 3 hours and 25 minutes after delivery to prevent postpartum hemorrhage due to heavy lochia. Conclusion(s): According to the pharmacokinetics of misoprostol and the patient’s responsiveness, the titrated oral use of misoprostol was effective. In the meantime, the uterine hyperstimulation resulting in acute fetal distress was also avoided. It is worthwhile to conduct a large trial to assess the effectiveness and safety of this regimen.

A survey of women's experiences of vaginal loss from 24 hours to three months after childbirth (the BLiPP study)

Objective: to describe the range of normal vaginal loss as reported by women from 24 hours after delivery until three months postnatally. Setting: two health districts in the south of England. Methods: a prospective survey of women's experiences and expectations of the duration, amount and colour of vaginal loss after childbirth. The term vaginal loss includes all types of fluid loss from the vagina following childbirth. Findings: five hundred and twenty-four women were recruited to the survey in 1995. Vaginal loss, as reported by the women, was considerably more varied in duration, amount and colour than descriptions in current midwifery textbooks. The median number of days reported for the duration of vaginal loss was 21 days and the interdecile range (10th to 90th percentile) was 10–42 days. For colour of lochia, women overall reported their vaginal loss to be more predominantly red/brown in colour and the traditional descriptions of the timing and colour phases of lochia rubra, serosa and alba are not supported by the majority of the women's experiences. Primiparous women were significantly more likely to report feelings of surprise or shock about their experiences of vaginal blood loss after the birth (odds ratio 4 [95% Confidence Interval 2–9]). Seven primiparous women (2%) were unaware that they would have a blood loss at all after the birth. Implications for practice: the findings from this survey have been used to develop information leaflets for women and health professionals about vaginal loss following childbirth. These leaflets include descriptions of normal ranges for the colour, amount and duration of vaginal loss in the first three months after childbirth.

Post-anaesthetic care: the postpartum woman

Giving birth to a baby is a miracle, not a disease! Barring complications, new mothers are postpartum women or puerperae, not patients! Therefore, the term 'patient' will not be used in connection with obstetrics in this chapter. For the first hour after parturition, special care is required for every new mother regardless of whether or not a major anaesthetic has been administered. When only a local infiltration technique is employed, this care may be provided in either the birthing room or the Post-anaesthetic Care Unit (PACU). Following a major anaesthetic, however, the puerpera must be managed in a PACU staffed by nurses knowledgeable not only of normal post-anaesthetic recovery but also of the normal anatomic and physiological puerperal adjustments. PUERPERAL ADJUSTMENTS The clinical manifestations of the puerperium, the 6-week period following parturition, reflect reversal of the anatomic and physiological adaptations to the pregnant state. This review will be limited to the changes of the early postpartum period. Immediately after placental expulsion, the involution of the uterus commences. The uterine body contracts forcefully, often producing 'afterpains', while the thinned-out lower segment contracts and retracts with less vigour. Sloughing of the decidual tissue results in a bloody vaginal discharge, the lochia rubra (red lochia) (Cunningham et al, 1993a). Urine production increases for two reasons, the infusion of intravenous fluids during labour and delivery and the sudden stoppage of the antidiuretic effect of the oxytocin injected after placental expulsion. Diuresis due to loss of the augmented extracellular water occurs later, usually between the second and fifth postpartum days. The urinary bladder has an increased capacity and a relative insensitivity to intravesical fluid pressure. Overdistention and incomplete emptying must be avoided as residual urine and bacteraemia, particularly in a traumatized bladder, facilitate the development of urinary tract infections (Cunningham et al, 1993a; Rolbin, 1993). The cardiac changeS are twofold, a decrease in heart rate and an increase in stroke volume. Following closure of the arteriovenous shunt across the

The duration of lochia

The duration of lochia and its association with a number of obstetric variables was studied in 236 women. Each woman completed a diary sheet describing the colour and duration of her lochia for up to 60 days post partum. The phases of lochia were divided according to the classical description; lochia rubra, serosa and alba. The median total duration of lochia was 33 days, lochia rubra 4 days and lochia serosa 22 days. Lochia persisted to 60 days in 13% of women. The duration of lochia was shorter in parous women and women with smaller babies.

The duration of lochia

Summary. The duration of lochia and its association with a number of obstetric variables was studied in 236 women. Each woman completed a diary sheet describing the colour and duration of her lochia for up to 60 days post partum. The phases of lochia were divided according to the classical description; lochia rubra, serosa and alba. The median total duration of lochia was 33 days, lochia rubra 4 days and lochia serosa 22 days. Lochia persisted to 60 days in 13% of women. The duration of lochia was shorter in parous women and women with smaller babies.