Bloody vaginal discharge forty days after childbirth

Many people think that menstruation stops after pregnancy, and even some other secretions disappear. In fact, the human vagina must have secretions to moisturize. Women will also have regular leucorrhea after pregnancy, but no menstruation. 40 days after delivery, the confinement period is basically over, and the body's functions are also recovering at this time. Leucorrhea may appear, and at the same time, it may contain blood. Is this normal?

Check medical history

You should inquire in detail about the amount of leucorrhea, whether it stains underwear or requires a menstrual belt; the color of the leucorrhea; whether there is any special odor; the time of occurrence; whether it irritates the vulva and causes itching; whether there has been a diagnosis of pathological leucorrhea in the past; what kind of treatment has been received; whether the spouse suffers from urinary and reproductive system diseases, etc.

Physical examination

The examination is carried out from outside to inside. First, the vulva, urethra, paraurethral glands and Bartholin's glands are inspected visually, and then the vaginal wall and cervix are observed through a vaginal speculum.

1. Visual examination of the vulva: This helps in the identification of vaginitis. Erythema and small collar fissures around the vulva and anus may be caused by candidiasis, and vulvar edema may be caused by trichomoniasis. The vulva of patients with Trichomonas vaginitis or cervicitis is often contaminated with a large amount of purulent vaginal discharge, while in bacterial vaginosis, only accumulated vaginal discharge is seen at the vaginal opening.

(ii) Appearance of vaginal discharge: Various pathological vaginal discharges have different specific characteristics that can provide diagnostic clues.

1. Physiological leucorrhea: The leucorrhea has the following characteristics: homogeneity, flocculence, high efficiency and accumulation in the sagging part of the vagina.

2. Bacterial vaginal discharge: The leucorrhea is gray, homogeneous, and has a low volume. It is often evenly attached to the surface of the vaginal mucosa on the anterior or lateral wall of the vagina. It is easy to wipe off and there is no obvious change in the vaginal mucosa.

3. Trichomonas vaginitis: The leucorrhea is yellow or even yellow-green, obviously purulent, and often foamy.

4. Candidiasis: The leucorrhea is white, highly viscous, and cheesy or tofu-like, attached to the vaginal wall. Sometimes it resembles white thrush-like patches. There may also be very little leucorrhea or it may be similar to normal leucorrhea, but the vaginal wall appears as white spots.

3. Cervical secretions: The cervix has clear fluid-like secretions before ovulation, which become thicker during the luteal phase.

1. Cervicitis: At any stage of the menstrual cycle, if there is purulent cervical discharge, the possibility of cervicitis should be considered. During the examination, the vaginal discharge outside the cervical opening should be wiped clean, and cervicitis can be diagnosed if there is purulent discharge in the endocervical canal lining. At this time, the columnar surface of the endocervical lining becomes erythematous and more brittle, and wiping with a cotton swab often causes bleeding.

2. Chlamydial cervicitis: In chlamydial cervicitis, the columnar epithelium often hypertrophies and protrudes above the squamous epithelium.

3. Malaria-related viral cervicitis: Ulcerative or necrotic lesions often appear in the columnar epithelium.

4. Gonorrheal cervicitis: Yellow, thick fluid or plugged liquid appears in the cervical canal, overflowing into the vagina and causing vaginitis, squeezing the urethra, paraurethral glands or Bartholin's glands, often with purulent discharge.

Laboratory tests

(I) pH value determination: Using a paper strip to measure the pH value of vaginal discharge has certain value for diagnosis. The pH value of normal vaginal discharge is ≤4.5, while the pH value of discharge caused by Trichomonas and bacterial vaginosis increases. (ii) Amine odor: All patients with excessive vaginal discharge should be tested for the presence of glue odor. First put a drop of 100% KOH solution on the glass slide and mix the leucorrhea with it. The leucorrhea of ​​bacterial vaginosis may emit a fishy odor, which is caused by the volatilization of amine in the discharge through alkalization. This situation occasionally occurs in cases of leucorrhea caused by trichomoniasis. Normal leucorrhea and Candida leucorrhea do not have this amine smell.

3. Microbial culture

1. Candidiasis: About 20% of people with candidiasis have negative KOH hanging drop smears. Therefore, patients with vulvar itching, high-risk patients with candidal infection (diabetic patients, patients taking broad-spectrum antibiotics and immunosuppressants for a long time), or patients with vaginal erythema who cannot be diagnosed by KOH specimens should be cultured for a definitive diagnosis.

2. Trichomoniasis: Trichomonas can be found in the leucorrhea of ​​most patients with trichomoniasis, but a considerable number of them also get false negative results. Because Trichomonas culture requires fresh culture medium to obtain stable results and is limited, culture is best limited to patients with leucorrhea containing a large number of white blood cells, suspected trichomoniasis and confirmed by microscopic examination, and patients at high risk of sexually transmitted diseases.