# Situation: The nurse from the Rural Health Unit (RHU) makes a home visit to a 20-year-old primipara on the fourth day after a normal vaginal birth. She is breastfeeding her term newborn, and her partner and her mother help at home. Before leaving, the nurse reviews the normal changes in lochia with the mother. Which statement by the mother shows that she needs **FURTHER** teaching?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629585  
> language: ko  
> subject: Nursing Practice II — Maternal and Child Health Nursing

## 문제

Situation: The nurse from the Rural Health Unit (RHU) makes a home visit to a 20-year-old primipara on the fourth day after a normal vaginal birth. She is breastfeeding her term newborn, and her partner and her mother help at home.

Before leaving, the nurse reviews the normal changes in lochia with the mother. Which statement by the mother shows that she needs **FURTHER** teaching?

## 보기

1. "Bright red flow that returns after pink flow is normal." **✔ 정답**
2. "It may still be yellowish white when I am 5 weeks postpartum."
3. "It may gush a little when I first stand up in the morning."
4. "The flow may get a little heavier while I breastfeed."

**정답: 1**

## 해설

Lochia changes from rubra (red, days 1 to 3) to serosa (pink to brown, about days 4 to 10) to alba (yellowish white, from about day 10 through 4 to 6 weeks). Flow normally increases briefly with breastfeeding (oxytocin contracts the uterus) and on standing (pooled blood). A return to bright red flow after lochia has become pink or white is not normal; it suggests subinvolution or retained tissue and should be reported.

## 심화 해설

Understanding Lochia Progression

Lochia is the vaginal discharge after birth, composed of blood, decidual tissue, and mucus. It follows a predictable sequence that reflects uterine involution. The normal pattern moves through three phases: lochia rubra (red, days 1–3), lochia serosa (pink to brown, approximately days 4–10), and lochia alba (yellowish white, from about day 10 through 4–6 weeks). On the fourth postpartum day, this mother is transitioning from rubra to serosa.

A return to bright red bleeding after the lochia has already lightened to pink or white is not a normal finding. This pattern suggests subinvolution of the uterus or retained placental fragments. Subinvolution means the uterus is not returning to its pre-pregnancy size and tone at the expected rate, often because of infection, retained tissue, or overdistention. The metabolomics study on postpartum uterine subinvolution [1] underscores that impaired uterine involution is a recognized puerperal complication requiring clinical attention. When a mother reports red bleeding that reappears after fading, the nurse should assess fundal height, tone, and tenderness, and report the finding for further evaluation.

Why the Other Statements Are Correct

| Statement | Physiologic Basis | Nursing Implication |
| --- | --- | --- |
| Yellowish white at 5 weeks postpartum | Lochia alba can persist until 4–6 weeks; a small amount of yellowish white discharge at 5 weeks is within normal limits. | Reassure the mother; no intervention needed. |
| Gush on first standing in the morning | Blood pools in the vagina while lying down and is released when upright. | Explain that this is expected; assess amount to rule out excessive bleeding. |
| Heavier flow while breastfeeding | Oxytocin released during breastfeeding causes uterine contractions, expelling pooled lochia. | Teach that this is a sign of uterine involution, not a complication. |

Key point! The direction of lochia change matters. Normal progression is red → pink → white, never the reverse. Any return to bright red bleeding after serosa or alba has begun warrants prompt reporting.

Watch out! Do not confuse the brief, expected increase in flow with breastfeeding or standing with a true recurrence of rubra. The former is transient and small in volume; the latter persists and may be accompanied by clots, cramping, or a boggy uterus.References (research sources)

- [1]Dynamic serum metabolomic changes during Chinese herbal hot compress therapy for postpartum uterine involution: pathway analysis and candidate biomarker identification.Research articleYin X, Liu X. (2026) · DOI: 10.3389/fmed.2026.1791959

## 임상 시나리오

Lochia Assessment After Vaginal BirthRecognizing abnormal bleeding patterns during home visits
Normal lochia progresses from rubra (red, days 1–3) to serosa (pink to brown, days 4–10) to alba (yellowish white, day 10 through 4–6 weeks). On day 4, transition from rubra to serosa is expected.

A return to bright red flow after lochia has already lightened to pink or white is abnormal. It suggests subinvolution or retained placental fragments and requires prompt reporting.

Expected variations include a small gush on standing from pooled blood, briefly heavier flow during breastfeeding due to oxytocin-induced uterine contraction, and lochia alba persisting until 6 weeks.

CautionIf the mother reports reappearing red bleeding, assess fundal height, tone, and tenderness, and report for further evaluation. Do not dismiss this as a normal lochia variation.

## 핵심 개념

- **lochia rubra** — Red vaginal discharge during days 1–3 postpartum, composed mainly of blood.
- **lochia serosa** — Pink to brown discharge from about days 4–10 postpartum as bleeding decreases.
- **lochia alba** — Yellowish white discharge from about day 10 through 4–6 weeks postpartum.
- **subinvolution** — Failure of the uterus to return to normal size and tone at the expected rate after birth.
- **oxytocin** — Hormone released during breastfeeding that stimulates uterine contraction and may increase lochia flow.

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