The World Health Organization multinational study of breast-feeding and lactational amenorrhea. IV. Postpartum bleeding and lochia in breast-feeding women. World Health Organization Task Force on Methods for the Natural Regulation of Fertility.
OBJECTIVE
To describe and compare the duration of lochia in seven groups of women; to investigate the occurrence of a possible "end-of-puerperium" bleeding episode; and to determine the frequency of bleeding episodes before postpartum day 56, which applies to the practice of the lactational amenorrhea method of contraception.


METHODS
Prospective longitudinal study with fortnightly follow-up, beginning within 7 days of delivery.


METHODS
Five developing and two developed countries.


METHODS
Four thousand one hundred eighteen breast-feeding women.


METHODS
Postpartum lochia and all days of bleeding per vaginam were recorded.


METHODS
Duration of lochia, frequency of an end-of-puerperium bleeding episode, and frequency of postlochia bleeding episodes within 56 days of delivery.


RESULTS
The median duration of lochia was 27 days; it varied significantly among the centers (range, 22-34 days). In 11% of the women, lochia lasted >40 days. An end-of-puerperium bleeding episode around the 40th day postpartum was reported by 20.3% of the women. Bleeding within 56 days of delivery (separated from lochia by at least 14 days) occurred in 11.3% of the women and usually was followed by a confirmatory bleeding episode 21-70 days later.


CONCLUSIONS
The duration of lochia varied significantly among the study populations, and long durations were not unusual. The significance of the end-of-puerperium bleeding episode is unknown. Most users of the lactational amenorrhea method will not experience a postlochia bleeding episode before postpartum day 56.
D000568:Amenorrhea; D001942:Breast Feeding; D003906:Developing Countries; D005260:Female; D006801:Humans; D007774:Lactation; D008137:Longitudinal Studies; D008598:Menstruation; D049590:Postpartum Period; D011446:Prospective Studies; D013997:Time Factors; D014592:Uterine Hemorrhage