An 8 days postpartum client reports persistent bright red bleeding after previously expected pinkish-brown lochia. What is most important to include in the plan for care?

• A. Schedule postpartum checkup
• B. Prepare to assist with retained placental fragments removal
• C. Advise heavy lifting after discharge
• D. Schedule ultrasound for fetal assessment

Answer: (B)

Persistent bright red bleeding eight days after birth points to retained placental fragments interfering with normal uterine involution. After delivery, lochia typically changes from bright red rubra to serosa and then alba over the next days to weeks. If bleeding remains bright red, it suggests tissue may be left in the uterus, which can prevent contraction and lead to ongoing hemorrhage or subinvolution. The most important plan is to prepare for removal of retained placental fragments, which may require procedures such as manual removal or currettage under obstetric supervision to restore the uterus’s ability to contract and stop the bleeding. In parallel, monitor uterine fundus, lochia amount and color, vitals, and signs of infection. Scheduling a postpartum checkup is important but does not address the immediate bleeding risk, while advising heavy lifting would worsen bleeding and a fetal ultrasound is not indicated for this postpartum complication.