![LOCHIA
In the field of obstetrics, lochia is the vaginal
discharge after giving birth (puerperium)
containing blood, mucus, and uterine tissue.[1]
Lochia discharge typically continues for 4 to 6
weeks after childbirth,[2] which is known as the
postpartum period.
It is sterile for the first 2 to 3 days, but not so by
the third or fourth day, as the uterus begins to be
colonized by vaginal commensals such as non-
hemolytic streptococci and E. coli.[3]](https://image.slidesharecdn.com/sadashivdawrepresentationofobgy-170919102110/85/Lecture-on-Lochia-and-deep-vein-thrombosis-3-320.jpg)
![COMPLICATIONS
In general, lochia has an odor similar to that of normal
menstrual fluid. Any offensive odor or change to a
greenish color indicates contamination by organisms
such as chlamydia or saprophytic.
Lochia that is retained within the uterus is known as
lochiostasis[5] or lochioschesis, and can result in
lochiometra[6] (distention of the uterus - pushing it out
of shape). Lochiorrhea describes an excessive flow of
lochia and can indicate infection.](https://image.slidesharecdn.com/sadashivdawrepresentationofobgy-170919102110/85/Lecture-on-Lochia-and-deep-vein-thrombosis-6-320.jpg)
Lecture on Lochia and deep vein thrombosis
- 1. CARE OF MOTHER MR. DAWRE SADASHIV G.
- 3. LOCHIA In the field of obstetrics, lochia is the vaginal discharge after giving birth (puerperium) containing blood, mucus, and uterine tissue.[1] Lochia discharge typically continues for 4 to 6 weeks after childbirth,[2] which is known as the postpartum period. It is sterile for the first 2 to 3 days, but not so by the third or fourth day, as the uterus begins to be colonized by vaginal commensals such as non- hemolytic streptococci and E. coli.[3]
- 4. STAGES ● Lochia rubra (or cruenta) is the first discharge, Composed of blood, shreds of fetal membranes, decidua, vernix caseosa, lanugo and membranes. It is red in color because of the large amount of blood it contains. It typically lasts no longer than 3 to 5 days after birth. ● Lochia serosa is the term for lochia that has thinned and turned brownish or pink in color. It contains serous exudate, erythrocytes, leukocytes, cervical mucus and microorganisms.
- 5. STAGES ● Lochia alba (or purulenta) is the name for lochia once it has turned whitish or yellowish-white. It typically lasts from the second through the third to sixth weeks after delivery. It contains fewer red blood cells and is mainly made up of leukocytes, epithelial cells, cholesterol, fat, mucus and microorganisms. Continuation beyond a few weeks can indicate a genital lesion, which should be reported to a physician.
- 6. COMPLICATIONS In general, lochia has an odor similar to that of normal menstrual fluid. Any offensive odor or change to a greenish color indicates contamination by organisms such as chlamydia or saprophytic. Lochia that is retained within the uterus is known as lochiostasis[5] or lochioschesis, and can result in lochiometra[6] (distention of the uterus - pushing it out of shape). Lochiorrhea describes an excessive flow of lochia and can indicate infection.
- 7. DEEP VEIN THROMBOSIS INTRODUCTION : DVT is the formation of a thrombus in the deep veins. Most commonly in the leg either above (proximal) or below (distal) the knee, or less commonly in the upper extremities May be spontaneous without a known underlying cause (unprovoked/idiopathic) provoked after events, such as trauma, surgery or acute illness (provoked) In the shorter-term, may lead to potentially life- threatening PE Long-term complications may include chronic conditions such as PTS
- 9. DIAGNOSIS Signs and symptoms Common symptoms of DVT include:2 ● Leg pain and tenderness ● Redness ● Oedema (swelling
- 10. Clinical probability scoring The Wells’ score is commonly used to evaluate the probability of DVT based on a patient’s medical history and physical examination. Clinical judgment plays a critical role because certain DVT risk factors and markers are evident early in the diagnostic process.
- 11. SCORING PARAMETER SCORE Active cancer (treatment ongoing or within previous 6 months or palliative) 1 Paralysis, paresis or recent plaster immobilization of lower extremities 1 Recently bedridden for more than 3 days or major surgery within 4 weeks 1 Localized tenderness along distribution of the deep vein system 1 Entire leg swollen 1 Calf swelling by more than 3 cm when compared with asymptomatic leg 1 Pitting oedema 1 Collateral superficial veins 1
- 12. SCORING Although a high Wells’ score indicates a clinical probability of DVT, an objective imaging technique such as compression ultrasonography, CT venography or MRI must be used to confirm or rule out DVT. D-dimer testing can also be used to rule out DVT. The flow diagrams below indicate the pathway for confirming or ruling out a diagnosis of DVT after the Wells’ score has been determined, as recommended by the American College of Chest Physicians (ACCP)5,6 and in the UK by the National Institute of Health and Care Excellence (NICE).
- 15. Diagnostic imaging Compression ultrasonography (also called venous ultrasonography or ultrasound) is the most widely used method for evaluating suspected DVT because it is safe and non-invasive.7 ● Involves compressing and imaging the femoral veins down to the most proximal calf veins8 ● Has some limitations but is considered acceptable for confirming suspected DVT when combined with a Wells’ score ≥2 (indicating DVT is likely)4
- 17. Alternatives to ultrasound are CT venography or MRI: ● CT venography detects both distal and proximal DVT but is invasive, painful and expensive, and is, therefore, usually used when ultrasound does not support the clinical suspicion of DVT but other assessments do ● MRI employs a powerful magnetic field to generate a high-resolution image of anatomic structures. It is non-invasive, but its use can be limited by a long examination time and a lack of access to equipment
- 18. D-dimer measurements D-dimer is a protein fragment produced by thrombus degradation and it forms when plasmin dissolves the fibrin strands that hold a thrombus together.11 A highly sensitive D-dimer test has high negative predictive value, meaning that it can be used to effectively rule out DVT in a patient with a negative ultrasound scan.