A 21-year-old G2P2 calls her physician 7 days postpartum because she is concerned that she is still experiencing vaginal bleeding. She describes the bleeding as light pink to bright red, and less heavy than the first few days postdelivery. She reports no fever or pain. On examination, she is afebrile and has an appropriately sized, nontender uterus. The vagina contains about 10 cc of old, dark blood. The cervix is closed.
Which of the following is the most appropriate treatment?
A. Antibiotics for endometritisThe bleeding this patient describes is normal. Bloody lochia can persist for up to 2 weeks without indicating an underlying pathology; however, if heavy bleeding continues beyond 2 weeks, it may indicate placental site subinvolution, retention of small placental fragments, or both. At that point, appropriate diagnostic and therapeutic measures should be initiated. The physician should first estimate the blood loss and then perform a pelvic examination in search of uterine subinvolution or tenderness. Excessive bleeding or tenderness should lead the physician to suspect retained placental fragments or endometritis. A larger than expected but otherwise asymptomatic uterus supports the diagnosis of subinvolution.