Which of the following findings is expected during the first 24 hours post delivery?

AIIMS Raipur - 2017 (Shift-3)

Obstetrics & Gynaecology

Easy

Appeared in: AIIMS Raipur - 2017 (Shift-3)

Explanation

In the first 1-4 days postpartum, the vaginal discharge is known as lochia rubra.
Lochia rubra is characterized by its bright red color, similar to a heavy menstrual period.
This discharge consists mainly of blood, decidual tissue, and small clots, which is a normal part of the uterine involution process as the placental site heals.

Option A: The absence of lochia (lochiometra) is abnormal and suggests a blockage or infection, preventing the normal shedding of the uterine lining.
Option B: A greenish discharge with a foul odor is a strong indicator of a puerperal infection, such as endometritis, and is a serious complication.
Option D: While very small clots are normal, the passage of large clots (e.g., larger than a golf ball) is a warning sign for postpartum hemorrhage, which could be due to uterine atony or retained placental tissue.

Visual 1: Infographic - An illustration showing the progression of lochia on sanitary pads from bright red (rubra) to pinkish-brown (serosa) to yellowish-white (alba), with a timeline for each stage. This helps learners visualize the expected color changes over the first few weeks postpartum.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Normal and abnormal findings during the postpartum period, specifically the characteristics of lochia as background academic context rather than a clinical decision trigger.
Assessment of lochia (color, amount, odor, and presence of clots) is a fundamental nursing responsibility in the postpartum period. It is a key indicator of uterine involution and helps in the early detection of major complications like postpartum hemorrhage (PPH) and infection.
A nurse should teach the patient how to monitor her own lochia and what warning signs to report, such as saturating a pad in one hour or less, passing large clots, or developing a foul odor.
What if? If a patient in the first 24 hours has bright red lochia but is saturating more than one perineal pad per hour, the answer changes. While the color is expected, the amount is excessive and indicates active postpartum hemorrhage, requiring immediate intervention such as fundal massage, administration of uterotonics, and notification of the provider.

How to Approach the Question

First, identify the specific timeframe mentioned in the question, which is 'the first 24 hours post delivery'.
Recall the normal physiological processes of the puerperium (the postpartum period).
Focus on the characteristics of lochia, the vaginal discharge after birth.
Remember the three stages of lochia: lochia rubra, lochia serosa, and lochia alba.
Associate the initial stage, lochia rubra, with the first few days postpartum (days 1-4). Its key characteristic is a bright red color.
Evaluate each option based on this knowledge. 'Bright red colour' aligns with the expected findings for lochia rubra.

Concept Tested & Keywords

Concept Tested: Normal and abnormal findings during the postpartum period, specifically the characteristics of lochia.
Stem keywords: findings, first 24 hours, post delivery
Lead-in keywords: expected

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