Is it normal for post-miscarriage lochia to have a foul, fishy odor?

Lochia after miscarriage is part of the uterine recovery process, during which residual blood, small amounts of leftover decidua, and necrotic endometrial tissue are expelled. Normal lochia usually has no odor; a foul or fishy smell often indicates infection and requires prompt medical evaluation. Cervical erosion, necrotic cervical polyps, cervical lesions, or even cervical cancer may also cause malodorous lochia, so careful differential diagnosis is necessary.

In the first 7 days after miscarriage, lochia is primarily bloody in nature. This occurs because the uterus has an open wound following the procedure, with some exposed blood vessels leading to bloody discharge. However, the amount is typically less than a normal menstrual flow and should resolve completely within 7 days. After the bloody lochia stops, white lochia appears, consisting mainly of white blood cells and possibly small amounts of non-pathogenic bacteria. During this phase, proper perineal hygiene is important, including frequent sanitary pad changes. This type of lochia usually clears up within 2–3 days.

After a miscarriage, it's important to closely monitor the amount and duration of lochia. If the discharge is unusually heavy or lasts longer than expected, an abdominal ultrasound should be performed under medical guidance to check for retained tissue in the uterus. If tissue remains, a second curettage may be recommended to prevent intrauterine infection.