Postpartum lochia is dirty and smelly
Introduction
Introduction Late postpartum hemorrhage is manifested as postpartum lochia that is not clean and odorous. Repeated or sudden vaginal bleeding can lead to anemia, shock and even life-threatening. Late postpartum hemorrhage refers to a large amount of bleeding in the uterus that occurs during the calving period after 24 hours of delivery, and the amount of bleeding exceeds 500 ml. The most common morbidity occurred 1 to 2 weeks after delivery, and it was late to 6 weeks after birth. Also known as puerperal bleeding. The incidence of late postpartum hemorrhage is closely related to the quality of prenatal care and obstetric quality. In recent years, with the increase of cesarean section rate, the incidence of late postpartum hemorrhage has an increasing trend.
Cause
Cause
1. Improper treatment of uterine incision in cesarean section is one of the important causes of late postpartum hemorrhage. In recent years, due to the increase of pregnancy pathological conditions and social factors, the importance of fetal attention and maternal fear and other factors have gradually increased the rate of cesarean section, postoperative complications also increased the level of surgeons during cesarean section and late postpartum The bleeding rate has a certain relationship.
(1) improper selection of uterine incision: the incision should be selected in the lower part of the uterus to avoid too high or too low. The incision is too high, located at the junction of the uterus and the lower segment. The thickness of the upper and lower tissues of the incision is uneven. The misalignment or misalignment can cause the uterine incision to heal poorly. The incision is too low and close to the cervix and cervical connective tissue, and the blood supply is poor. Causes the uterine incision to heal poorly, and it is easy to cause tearing of the incision when the fetal head is born.
(2) Inappropriate incision method: When incision, use a scalpel or scissors to cut or cut the whole process, causing the arch wall of the uterine wall to break, and bleeding, affecting healing.
(3) Incision tearing when the fetal head is delivered: When the fetal head is out of the way, the action is rough or the giant child is deformed. The incision tear is easy to occur when the placenta is placed. As the uterus of the pregnancy is displaced by the sigmoid colon, the uterus is right-handed, so the left corner of the incision is easily torn, involving the uterine artery. When the bleeding occurs, the surgeon is nervous. Repeated sutures at the torn site can cause hemorrhage in the uterine horn. Obstruction, easy necrosis, splitting, bleeding.
(4) Improper suture: the needle spacing is too close, the suture is too tight, which can affect the local blood circulation and make the incision heal. In addition, suturing the endometrium into the muscular layer during suturing is also one of the reasons that affect the healing of the uterine incision.
2. Infection: Before the delivery, there are premature rupture of membranes, prolonged labor, repeated vaginal examination, induced rupture of artificial ruptured water sac or oral vaginal operation with balloon. The mother has severe anemia during pregnancy and severe pregnancy-induced hypertension. When pathological conditions such as diabetes, and vaginal hygiene after childbirth do not pay attention to fear of pain, do not clean the perineum, can occur intravaginal and intrauterine infection, resulting in poor uterine incomplete or poor wound healing and late postpartum hemorrhage.
3. Uterine incompleteness: Intrauterine infection and a small amount of placental membrane residual can cause uterine insufficiency.
4. Placental polyps: If the placenta membrane remains during childbirth, the residual tissue is deposited in the intrauterine necrotic surface fibrin to form polyps.
5. Others: endometritis, uterine submucosal fibroid infection, choriocarcinoma, can also cause late postpartum hemorrhage.
Examine
an examination
Related inspection
Obstetric B ultrasound routine
In clinical practice, patients who have seen postpartum lochia and have odors can make a diagnosis based on medical history, clinical signs and auxiliary examinations. Please note:
(1) After 24 hours of childbirth, uterine bleeding occurred during the puerperium period, and the postpartum lochia was not clean. The blood color changed from dark to red, accompanied by odorous bleeding during infection, low blood volume or moderate health search, and a large amount of bleeding may accompany clots. The patient has a shock when he has been bleeding for a long time.
(2) There is a history of lower abdominal pain, low fever or low postpartum fever.
(3) The uterus is slightly larger and softer. When there is a tender incision at the uterus or incision, the hematoma can form a mass, the cervix is loose, and sometimes the residual placental tissue can be touched.
(4) Blood routine shows anemia and infection.
(5) B-ultrasound examination revealed residual tissue in the uterine cavity or hematoma in the lower uterine incision after cesarean section, poor healing or tumor lesions in the uterus.
Diagnosis
Differential diagnosis
The diagnosis of postpartum hemorrhage is not difficult to make. The key point and difficulty of diagnosis is to find the cause of bleeding according to the treatment and stop bleeding quickly. Therefore, there are four major causes of postpartum hemorrhage: uterine contraction, placental factors, soft birth canal injury, and coagulation mechanisms.
1. Diagnosis can be made based on medical history, clinical signs and auxiliary examinations.
2. Diagnostic criteria
(1) After 24 hours of childbirth, uterine bleeding occurred during the puerperium period, and the postpartum lochia was not clean. The blood color changed from dark to red, accompanied by odorous bleeding during infection, low blood volume or moderate health search, and a large amount of bleeding may accompany clots. The patient has a shock when he has been bleeding for a long time.
(2) There is a history of lower abdominal pain, low fever or low postpartum fever.
(3) The uterus is slightly larger and softer. When there is a tender incision at the uterus or incision, the hematoma can form a mass, the cervix is loose, and sometimes the residual placental tissue can be touched.
(4) Blood routine shows anemia and infection.
(5) B-ultrasound examination revealed residual tissue in the uterine cavity or hematoma in the lower uterine incision after cesarean section, poor healing or tumor lesions in the uterus.
