What is it about ?
After childbirth (postpartum), vaginal discharge lasts an average of 4 to 8 weeks. The discharge lasts for more than 6 weeks in about 1 in 4 women, especially when breastfeeding.
- During the first few days, the bleeding is profuse and the blood is bright red.
- After 3 to 4 days, the bleeding gradually subsides and turns to a reddish-brown color.
- A week later, the discharge turns yellow or white.
The amount of vaginal discharge varies from day to day. The losses are more abundant if there are lesions in the vagina or the cervix during childbirth. If the blood loss exceeds half a liter (500 ml) within 24 hours of giving birth, this is called primary postpartum hemorrhage (this situation will not be covered here). Secondary postpartum hemorrhage is any significant or abnormal vaginal bleeding that occurs more than 24 hours and up to 6 weeks after childbirth.
The possible causes are:
- placenta residues;
- lesions in the vagina or cervix;
- complications from the cut (episiotomy) performed to facilitate childbirth;
- inflammation of the lining of the womb (endometritis);
- in very rare cases, a malignant tumor of the placenta.
Inflammation of the lining of the womb (endometritis) after childbirth is also called “puerperal fever”. It is caused by bacteria that travel from the vagina to the uterus. The risk of inflammation of the uterine lining is increased in the following situations:
- a long childbirth;
- premature rupture of the water bag;
- frequent internal reviews;
- the use of forceps or a suction cup;
- a cesarean, for example when pieces of the placenta are left in the uterus.
If the inflammation of the uterine lining is not treated in time, the infection can spread and have very serious consequences.
What is their frequency?
Secondary postpartum hemorrhage affects about 1 in 100 women.
Inflammation of the uterine lining after childbirth (postpartum endometritis) is much less common than in the past thanks to improved hygiene conditions during childbirth.
How to recognize them?
You can recognize secondary postpartum hemorrhage when the vaginal discharge becomes abundant again and returns to a bright red color.
Inflammation of the lining of the womb usually develops between the 4th and the 10th day after childbirth, but can also happen later. The symptoms are
- fever ;
- pain in the lower abdomen which may radiate throughout the abdomen;
- smelly vaginal discharge.
How is the diagnosis made?
Your doctor will start by asking you a few questions about the progress of your pregnancy and childbirth, then perform a clinical and gynecological examination. They will also do a blood test for you.
If he thinks there are pieces of the placenta left in the uterus, an ultrasound will be done.
If he thinks of an infection, your doctor will also order a urinalysis to be sure it is not (also) a urinary tract infection. He will also take a sample of the vaginal discharge so that the lab can identify the bacteria responsible.
What can you do ?
If you experience excessive and persistent bleeding after childbirth, see your doctor as soon as possible. Likewise, it is strongly recommended that you consult your doctor if you develop a fever of 38 ° C or higher in the week following delivery, if you experience increasingly severe stomach aches and if your vaginal discharge smells bad. .
What can your doctor do?
If you lose a lot of blood, the doctor will take you to hospital. If the bleeding is caused by lesions in the cervix or vagina, the doctor may be able to suture it. If the bleeding is due to the presence of placenta residue, a scraping of the inner lining of the uterus (curettage) will be performed. Antibiotics are sometimes prescribed to prevent infection.
Inflammation of the uterine lining requires antibiotics. In severe forms, hospitalization is necessary for the administration of antibiotics by infusion. In more than 9 out of 10 cases, the situation improves within 2 to 3 days. If this is not the case, additional examinations are necessary (ultrasound, scanner (CT scan), magnetic resonance imaging (MRI)).