Lochia congestion (synonyms: puerperal congestion, lochial congestion, lochiometra) is a condition that occurs in women in childbirth. The absence or inadequacy of lochial flow may be accompanied by nonspecific symptoms and is therefore not taken seriously by some young patients. Nevertheless, the woman in childbirth should contact her gynecologist as soon as possible.
What is pelvic congestion?
Lochial congestion is a postpartum condition characterized by low or cessation of postpartum flow. It is also called lochial congestion and postpartum congestion. Postpartum wound secretions, which normally drain from the vagina without problems, accumulate in the uterine cavity. The sore uterine mucosa following the shedding of placenta and egg membrane remnants is normally protected from infection by the secretion of the postpartum flow and can heal. However, if lochia congestion occurs, the lochia, consisting of dead tissue remnants, bacteria, white blood cells, blood, serous fluid and vaginal secretions, decompose. In the worst case, inflammation of the uterus occurs and – if the pathogens move on to the ovaries – inflammation of the fallopian tubes and ovaries. In very rare cases, the young mother may even get life-threatening blood poisoning.
Causes
Lochal congestion can have several causes. In cesarean and natural births, for example, a cervical spasm or a collection of clotted blood (coagula) located there may cause the cervix to become narrowed or completely closed. The undiscarded egg skin remnants can also block the cervical canal. In addition, a uterus that is directed backward or strongly forward (retroflexio uteri or hyperanteflexio uteri, respectively) may be to blame for the development of a lochia. In this case, the cervix is bent so that the postpartum flow cannot pass through the vagina. Even an overfull bladder or rectum can cause lochial congestion.
Symptoms, complaints and signs
The main symptom of puerperal congestion is, of course, the absence, abrupt cessation, or insufficient quantity of discharge from the uterus. The woman in labor develops a high fever (more than 38 °C) during the first two to seven days after delivery. Her uterus is greatly enlarged and can be easily palpated after emptying the bladder. It feels soft, but hurts when light pressure is applied to it. This is usually accompanied by severe abdominal pain and nonspecific symptoms of illness such as headache and earache. The forehead headache is stabbing to pulling and emanates from both temples. Because these symptoms also occur in conjunction with other conditions, pitting is sometimes not taken seriously. If lochia is merely reduced, the discharged secretion often has a foul odor. Instead of contacting the gynecologist immediately, some new mothers prefer to increase their hygiene measures because they have the impression that it is a hygienic problem. If the woman in childbirth notices that the postpartum flow suddenly dries up only a few days after giving birth or that only little fluid is secreted, she should see her gynecologist as soon as possible.
Diagnosis and course of the disease
Lochia congestion can be seen very clearly on ultrasound of the lower abdomen. The doctor can see clearly that the uterus is filled with fluid. Palpation of the uterus reveals that the uterus is greatly enlarged, indicating inadequate involution.
Complications
Lochia congestion usually results in relatively high fever, causing the patient to be severely fatigued. The quality of life is also significantly reduced by this disease. Sufferers feel tired and there is a reduced ability to work under pressure. Furthermore, there is also pain in the abdomen and in the head. This pain can also spread to neighboring regions. Furthermore, pain at night also leads to sleep disturbances and possibly to depression. In many cases, pitting is diagnosed late because the symptoms do not seem particularly dangerous. However, this condition requires immediate examination by a gynecologist to avoid complications. The uterus may be greatly enlarged due to lochia congestion and may not regress.Pitting can be treated with the help of various medications or antibiotics Complications do not occur and the discomfort disappears relatively quickly. The complaints can also be limited by various means of self-help. If the treatment is successful, there are no further complications and the patient’s life expectancy is not reduced by the lochia congestion.
When should you see a doctor?
A new mother’s body performs at its best in the days and weeks following childbirth. At the same time, it is vulnerable, which is why the affected woman should definitely see a gynecologist if she experiences any unusual symptoms. A lochia congestion is therefore a case for the gynecologist from the very first suspicion. The inside of the uterus needs weeks to heal completely. Until it has reached this stage, the accumulated postpartum flow poses a high risk of infection. The first symptoms of infection may appear just a few days after the onset of pelvic congestion. This can increase to puerperal fever and be a life-threatening risk for the woman even in modern times. In earlier centuries, as well as in continents with less consistent medical care and hygienic standards, it remains one of the leading causes of death among young mothers. A lochia detected early enough can be treated well, and depending on the cause, the woman may even avoid hospitalization. On the other hand, if it was not noticed until after the first symptoms appeared, it may be reasonable to accept hospital admission for observation. The maternity ward usually welcomes patients’ babies, so there need not be any separation of mother and child at all for treatment of lochia.
Treatment and therapy
Lochia congestion is usually relieved with a combination of different treatments. To relax the cramped cervix, the doctor gives the patient antispasmodic medications (spasmolytics) such as Buscopan. A short infusion of oxytocin induces postpartum contractions. The uterine muscles contract, which then triggers lochia. The contraceptive can also be administered as a nasal spray. Alternatively, the new mother must take methergine as drops or lozenges. The drug contains methylergometrine, an active substance that also causes uterine contractions. If an abdominal infection is imminent or already present, the gynecologist prescribes antibiotics to kill the pathogens. If the cervix is obstructed by coagula, they are removed immediately so that the congested lochia can drain freely again. The constricted cervical canal is slightly dilated by the gynecologist. Until the lochia drain again, the young mother should keep in daily contact with her gynecologist or midwife. She will inform him/her about the amount, color and smell of the discharged lochia. Apart from the medical measures carried out in the gynecologist’s office, the new mother herself can contribute to the resumption or increase of the necessary lochia. At least twice a day, the woman lies on her stomach with a pillow placed under her uterus and stays in this position for 30 minutes. This stimulates the contraction of the uterus. Massaging the lower abdomen in the uterine area can also help to relieve the congestion of the lochia. Heat further promotes lochia discharge. Hot sitz baths with chamomile or oak bark extract from the pharmacy are also a proven remedy. However, the water should only reach up to the navel. Since the lochia are sometimes infectious, it is advisable not to immerse the breasts in the water. Applying a heat pack can also help. Those who like teas can also prepare a shepherd’s purse or lady’s mantle tea to eliminate lochia congestion.
Outlook and prognosis
Normally, the prognosis of pitting congestion is favorable. Medical treatment is initiated, which shows sufficient effect after a short time under optimal conditions. Within a few weeks, the patient should be completely free of symptoms. Long-term discomfort is usually not to be expected. If the affected person supports the healing process by regular massages of the lower abdomen, in many cases an improvement of the situation is already documented in the following hours.In addition, further self-help measures can be taken that are helpful for a good prognosis. It is therefore also possible to achieve freedom from symptoms without having to seek medical care. However, to avoid complications or irregularities, this is not recommended. A combination of medical care and measures taken on the patient’s own initiative is optimal. In the case of severe disease progression, surgical intervention is necessary. This is routinely performed and is usually without further complications. In exceptional cases, the course of the disease is unfavorable. Sepsis may occur. This is a potential threat to the patient’s life, as the blood poisoning can take a fatal course. For this reason, if symptoms increase, cooperation with a physician should take place immediately to maintain the prospect of a good recovery.
Prevention
In order to avoid congestion of the postpartum flow, the young mother should consistently perform her postpartum gymnastics for regression. Mobilization right after delivery (getting up frequently) can also help prevent the condition. Regular breastfeeding of the baby ensures that the body releases more oxytocin, which stimulates the contraction of the uterus and promotes postpartum flow.
Aftercare
Because pelvic congestion is generally very good and easy to treat, follow-up care in this case is more preventive in nature. However, caution should be exercised if depression should occur. It may then be advisable to seek professional psychological support in order to avert a consolidation and to bring the quality of life back to the usual level as quickly as possible. The help of friends and family can have a lasting positive effect.
This is what you can do yourself
In the case of lochia congestion, the patient should take it easy. The organism needs rest and should not be overstrained. In addition, an adequate supply of fluids is important. Fever occurs with lochia congestion. In the worst case, a lack of fluids can lead to dehydration and thus to dehydration. Since this is a life-threatening condition, attention must be paid to how much fluid has been ingested daily. In addition, an adequate supply of heat is helpful. If the abdomen is warmed with hot water bottles or electric blankets, this will promote lochia flow. Sitz baths or the consumption of warm teas are also recommended. Supportive massages of the lower abdomen can be performed. With light pressure and circular movements, there is a stimulation of the circulation. This gives the possibility to minimize or dissolve the congestion. The massages can be performed by the patient independently at any time according to her own needs. Relaxation techniques can be used to relieve pain and build up a sense of well-being. Through a meditative state or autogenic training, the inner forces are mobilized and stressors are reduced. Agitation and hectic are to be avoided. Conflicts or other disagreements should be postponed so that no new stressful situations arise. On the other hand, optimistic and joyful conversations with fellow human beings are helpful.
