Lochia Stages on the NCLEX
Lochia rubra, serosa, and alba: timing, normal amounts, and the abnormal findings NCLEX tests.
Lochia questions test timing and the abnormal findings. The sequence never runs backward in a normal recovery.
The normal sequence
Rubra: dark red, days 1-3. Small clots can be normal. Serosa: pink to brown, roughly days 4-10. Alba: white to pale yellow, after day 10, lasting up to 4-6 weeks. Flow decreases over time. Breastfeeding and ambulation can cause brief, mild increases in flow. Lochia after cesarean is typically lighter.
Abnormal findings
Reverting to rubra after progressing → late hemorrhage or retained placental fragments. Foul odor → endometritis. Fleshy or musty is normal; foul is not. Saturating a pad in 1 hour or less, or clots larger than a golf ball → hemorrhage assessment now: fundus, vitals, bladder. No lochia at all in the first days is also abnormal outside of expected post-cesarean reduction.
How to assess
Quantify by pad saturation over a timed hour, and weigh pads when accuracy matters: 1 g = 1 mL of blood loss. Always check under the buttocks; blood pools. Chart amount as scant, light, moderate, or heavy per facility scale, plus color and odor.
Frequently asked
Patient on day 5 has pink-brown discharge. Normal?
Yes. That is serosa, on schedule. Teach her to report a return of bright red bleeding, foul odor, or fever.
Gush of blood when she stands up?
Often pooled lochia from lying down, which is normal once. Continued heavy flow after the initial gush is not. Reassess the fundus and the pad count.
Quick check
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