20 days after delivery, the lochia is almost gone and there is blood again

Many pregnant mothers will encounter many gynecological problems after giving birth. For example, lochia. After giving birth, there will be lochia, but it will disappear after a few days. However, in some cases, postpartum lochia will continue and even blood may appear. If lochia lasts for 4 to 6 weeks, you should pay attention. It is best to treat the cause to avoid leaving any health risks.

There are many reasons for prolonged lochia after delivery, such as endometritis; partial retention of the placenta and fetal membranes; myometritis or pelvic infection; uterine submucosal or intramural tumors; uterine adenomyoma; excessive retroversion or retroflexion of the uterus; excessive amniotic fluid and excessive placenta that weakens the uterine muscle contraction and affects uterine involution, etc. Postpartum uterine trophoblastic tumors can also cause uterine bleeding.

1. Tissue residue

If the B-ultrasound examination indicates a light mass in the uterus, a uterine curettage must be performed. Women who have given birth naturally can undergo a uterine curettage directly. If the woman has had a cesarean section, it is recommended that a uterine curettage be performed under B-ultrasound positioning, which is safer. After the operation, treatment should be given to prevent infection and promote uterine contraction.

2. Poor postpartum uterine involution

B-ultrasound often shows that the uterus is enlarged, there is fluid accumulation in the uterine cavity, and there is a high possibility of blood accumulation. Due to poor uterine contraction after delivery, there is residual fluid and blood in the uterus, which leads to irregular vaginal bleeding. If this is the case, oxytocin must be injected intramuscularly or intravenously, and then Chinese medicine should be used to promote uterine contraction. If necessary, oral antibiotics should be taken to prevent infection. Adherence to breastfeeding is beneficial to postpartum uterine contraction and recovery.

3. Puerperal infection

Endometrial inflammation leads to postpartum lochia. If this is the case, routine blood tests will indicate elevated white blood cells and neutrophil ratio, and B-ultrasound examination often shows no obvious abnormalities. In this case, intravenous anti-infection treatment is required. If breastfeeding is ongoing, it is best to use a third-generation cephalosporin antibiotic combined with metronidazole intravenous drip for 3 to 5 days.