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Discussion

Estimating Lochia

So I'm doing my maternity/peds rotation in clinical and unfortunately I haven't had maternity/peds in class yet. Things are done a little backwards where I go to school. To compensate for that, my clinical instructor gave us a postpartum packet to fill out so we have a general knowledge. I'm having trouble finding answers for this question:

Explain the standardized method for estimating lochia after delivery.

Scant:

Light:

Scant Moderate:

Heavy:

It seems pretty self explanatory. It just goes from lightest to heaviest. However since the question asks for the standardized method, I'm not sure what I'm looking for. Also just for clarification, I don't need info on rubra, serosa or alba. That was pretty easy to find. Any help would be appreciated. I'm not asking for outright answers. A point in the right direction would be appreciated. Thanks.

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    • Expert

    Do you have a textbook you can consult (say, maybe in the library on campus)? A lot of times they will have visual estimates (on a sanitary pad for reference) of each quantity.

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    • Author

    That was the first place I looked. Unfortunately all it says is that soaking 1 pad in one hour is heavy bleeding.

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    Perhaps the word "standardized", is throwing you off. I believe the question is asking you what method does the nurse utilize to estimate lochia, amount color etc. the use of that word just makes it confusing, one of the many things I don't miss about nursing school :p

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    "Standardized" makes this sound more objective than subjective, when in reality, it's VERY subjective. Unfortunately, it's not one of those, "One inch spot per hour is scant, 3 inches is light" etc. It's basically experience and comparing what you've seen and comparing. Which I know doesn't help, but that's the reality of nursing versus nursing school for you! :)

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    As someone who has only been an L&D nurse for about 6 months (I graduated last May), I can tell you that it is indeed very subjective. However, I just ask for a second opinion whenever I'm on the fence about what is normal vs. what is ominous. Just the other night I asked a more experienced nurse to take a look at the clots that my patient passed. She said that she completely understood why I asked, however, she wasn't concerned because the patient breastfed so long, had an extremely precipitous delivery, and only had scant bleeding for the first hour or so. Does this make sense? Each situation is so unique that it's difficult to explain. My best advice is to trust your gut.

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    For "standardized" all I can think of us to weigh the pads before and after use. One gram is about one cc of blood. California has a very extensive program on preventing postpartum hemorrhage. Google it and you'll find lots of resources.

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    This is a VERY subjective measurement. There's just no way around it. EBL after birth is so subjective, it is almost laughable. Do you think she had a PPH? Was it a pretty decent bleed? Then her EBL is probably like 700mL at least! Normal, spontaneous birth? Looks like about 250mLs to me!

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    Haha... I got scolded by my clinical instructor today about this very subject.

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