The nurse in the postnatal area noticed that women who delivered before 2 days have discharge from the vagina, which is reddish. The nurse documented that this would be:

1. A

   Lochia alba

2. B

   Leucorrhea

3. C

   Lochia serosa

4. D

   Lochia rubra

Appeared in: DSSSB 13 August 2024

Explanation

• Lochia rubra is the initial vaginal discharge following childbirth, lasting for the first 1 to 4 days.
• It is characterized by its bright red color due to the presence of blood, decidual tissue, and trophoblastic debris from the placental site.
• The clinical scenario describes a reddish discharge two days after delivery, which perfectly aligns with the definition of lochia rubra.

Why Other Options Were Wrong

• Option A: Lochia alba is the final stage of postpartum discharge, typically occurring from day 10 to day 15 (or longer). The discharge is pale white or yellowish-white, not red.
• Option B: Leucorrhea is a general medical term for a whitish or yellowish vaginal discharge. It is not specific to the postpartum period and does not describe the normal, bloody discharge seen after delivery.
• Option C: Lochia serosa is the second stage of postpartum discharge, occurring from approximately day 5 to day 9. The discharge is pinkish or brownish as the blood content decreases and is replaced by wound exudate and leukocytes.

Related Visual

Clinical Relevance

• Nursing practice connection: Safe nursing care depends on performing Normal physiological changes during the puerperium, specifically the stages and characteristics of lochia in the correct sequence, documenting the action clearly, and monitoring for the expected response.
• Assessing the color, amount, and odor of lochia is a critical nursing intervention to monitor uterine involution and detect postpartum complications.
• Persistence of lochia rubra beyond the first week, a foul odor, or excessive bleeding can indicate problems such as subinvolution, retained placental fragments, or infection (endometritis), which require prompt medical attention.
• What if? If a woman calls on day 14 postpartum stating her discharge, which had become whitish, has now turned bright red again and is heavier, this is an abnormal finding. It could signify late postpartum hemorrhage due to subinvolution of the placental site or retained placental fragments and requires immediate evaluation by a healthcare provider.

How to Approach the Question

• Identify the key information in the question: the patient is in the postnatal period, the time is 2 days after delivery, and the discharge is reddish.
• Recall the three stages of postpartum vaginal discharge, known as lochia.
• Remember the characteristics of each stage: Lochia rubra (red, days 1-4), Lochia serosa (pinkish/brown, days 5-9), and Lochia alba (whitish/yellow, from day 10).
• Compare the information from the question to the stages of lochia.
• The description of reddish discharge at 2 days postpartum directly matches the characteristics of Lochia rubra.
• Eliminate the other options based on their incorrect timing and color descriptions.

Concept Tested & Keywords

• Concept Tested: Normal physiological changes during the puerperium, specifically the stages and characteristics of lochia.
• Stem keywords: postnatal, 2 days, discharge, reddish
• Lead-in keywords: documented that this would be
• Clinical cues: The timing of the discharge (2 days postpartum) and its color (reddish) are the key details for identifying the correct stage of lochia.

Question ID

QHCdB2trsNdLe6D6DkqI2H

Copy ID

Reference Book

E6 Midwifery Obstetrics and Gynecology Nursing Sandeep Kaur pp. 1-5, 51-62

E6 Obstetrics Williams p. 45-63