North American Registry of Midwives (NARM) Practice Exam

Which type of lochia has the strongest odor?

1. Lochia rubra

2. Lochia serosa

3. Lochia alba

4. None of the above

The correct answer is: Lochia serosa

Lochia serosa is considered to have the strongest odor compared to the other types of lochia. This type of lochia occurs approximately four to ten days postpartum and is characterized by a pinkish-brown color, consisting of mainly serous fluid, leukocytes, and some red blood cells. The increase in fluid content and decomposition of blood can lead to a more pronounced odor during this phase. Lochia rubra, which occurs in the first few days postpartum, primarily consists of fresh blood and has a more metallic or earthy smell, typically due to the presence of red blood cells. On the other hand, lochia alba, which follows lochia serosa, is much lighter in color and odor, primarily consisting of white blood cells and tissue debris, leading to a minimal or no odor at all. Therefore, lochia serosa's composition and timing contribute to it having the strongest odor among the different stages of postpartum vaginal discharge.