Lochia and Deep vein thorobosis

1. CARE OF MOTHER
MR. DAWRE SADASHIV G.

2. SADASHIV'S FOUNDATION

3. LOCHIA
In the field of obstetrics, lochia is the vaginal
discharge after giving birth (puerperium)
containing blood, mucus, and uterine tissue.[1]
Lochia discharge typically continues for 4 to 6
weeks after childbirth,[2] which is known as the
postpartum period.
It is sterile for the first 2 to 3 days, but not so by
the third or fourth day, as the uterus begins to be
colonized by vaginal commensals such as non-
hemolytic streptococci and E. coli.[3]

4. STAGES
● Lochia rubra (or cruenta) is the first discharge,
Composed of blood, shreds of fetal membranes,
decidua, vernix caseosa, lanugo and
membranes. It is red in color because of the
large amount of blood it contains. It typically lasts
no longer than 3 to 5 days after birth.
● Lochia serosa is the term for lochia that has
thinned and turned brownish or pink in color. It
contains serous exudate, erythrocytes,
leukocytes, cervical mucus and microorganisms.

5. STAGES
● Lochia alba (or purulenta) is the name for lochia
once it has turned whitish or yellowish-white. It
typically lasts from the second through the third
to sixth weeks after delivery. It contains fewer
red blood cells and is mainly made up of
leukocytes, epithelial cells, cholesterol, fat,
mucus and microorganisms. Continuation
beyond a few weeks can indicate a genital
lesion, which should be reported to a physician.

6. COMPLICATIONS
In general, lochia has an odor similar to that of normal
menstrual fluid. Any offensive odor or change to a
greenish color indicates contamination by organisms
such as chlamydia or saprophytic.
Lochia that is retained within the uterus is known as
lochiostasis[5] or lochioschesis, and can result in
lochiometra[6] (distention of the uterus - pushing it out
of shape). Lochiorrhea describes an excessive flow of
lochia and can indicate infection.

7. DEEP VEIN THROMBOSIS
INTRODUCTION :
DVT is the formation of a thrombus in the deep veins.
Most commonly in the leg either above (proximal) or
below (distal) the knee, or less commonly in the upper
extremities
May be spontaneous without a known underlying
cause (unprovoked/idiopathic) provoked after events,
such as trauma, surgery or acute illness (provoked)
In the shorter-term, may lead to potentially life-
threatening PE
Long-term complications may include chronic
conditions such as PTS

9. DIAGNOSIS
Signs and symptoms
Common symptoms of DVT include:2
● Leg pain and tenderness
● Redness
● Oedema (swelling

10. Clinical probability scoring
The Wells’ score is commonly used to evaluate
the probability of DVT based on a patient’s
medical history and physical examination. Clinical
judgment plays a critical role because certain DVT
risk factors and markers are evident early in the
diagnostic process.

11. SCORING
PARAMETER SCORE
Active cancer (treatment ongoing or within previous 6 months or palliative) 1
Paralysis, paresis or recent plaster immobilization of lower extremities 1
Recently bedridden for more than 3 days or major surgery within 4 weeks 1
Localized tenderness along distribution of the deep vein system 1
Entire leg swollen 1
Calf swelling by more than 3 cm when compared with asymptomatic leg 1
Pitting oedema 1
Collateral superficial veins 1

12. SCORING
Although a high Wells’ score indicates a clinical
probability of DVT, an objective imaging technique such
as compression ultrasonography, CT venography or MRI
must be used to confirm or rule out DVT. D-dimer testing
can also be used to rule out DVT.
The flow diagrams below indicate the pathway for
confirming or ruling out a diagnosis of DVT after
the Wells’ score has been determined, as recommended
by the American College of Chest
Physicians (ACCP)5,6 and in the UK by the National
Institute of Health and Care Excellence (NICE).

15. Diagnostic imaging
Compression ultrasonography (also called venous
ultrasonography or ultrasound) is the most widely used
method for evaluating suspected DVT because it is safe
and non-invasive.7
● Involves compressing and imaging the femoral veins
down to the most proximal calf veins8
● Has some limitations but is considered acceptable for
confirming suspected DVT when combined with a Wells’
score ≥2 (indicating DVT is likely)4

17. Alternatives to ultrasound are CT
venography or MRI:
● CT venography detects both distal and proximal
DVT but is invasive, painful and expensive, and
is, therefore, usually used when ultrasound does
not support the clinical suspicion of DVT but
other assessments do
● MRI employs a powerful magnetic field to
generate a high-resolution image of anatomic
structures. It is non-invasive, but its use can be
limited by a long examination time and a lack of
access to equipment

18. D-dimer measurements
D-dimer is a protein fragment produced by
thrombus degradation and it forms when plasmin
dissolves the fibrin strands that hold a thrombus
together.11 A highly sensitive D-dimer test has
high negative predictive value, meaning that it can
be used to effectively rule out DVT in a patient
with a negative ultrasound scan.