Subinvolution process - post partum period

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1. Subinvolution of uterus Komal A. Sabane 4 th year B.BSc Nursing GTCN , Solapur

2. Introduction Puerperium period is the period after the completion of parturition, including third stage of labour when the genital system is returning to its normal non pregnant stage. Extension of puerperium may have detrimental effect on reproductive performance of animal.

3. WHAT IS INVOLUTION OF UTERUS ?

4. INTRODUCTION Involution of the uterus : Involution is a process whereby the genital organs revert back approximately to the state as they were before pregnancy.

5. Immediately following delivery : At umbilicus . Rate of involution : 1cm / day Becomes pelvic organ : 10- 12 days

6. Size of Uterus : Non pregnant state- 7.5 cm in length and 60 GM in weight . Pregnant state – 35 cm in length and 900- 1000gm in weight . Puerperium – 7.5 cm in length and 60 gms in weight.

7. What is the Subinvolution of Uterus ?

8. Sub involution

9. Subinvolution Definitions – The medical condition when the involution of uterus is impaired or retarded it is known as subinvolution of uterus. ( Acc. To D.C. Dutta )

10. Delayed or absent involution of the uterus during the postpartum period is known as subinvolution of uterus ( Acc . To Medical Dictionary )

11. Incidence rate Subinvolution of uterus is a relatively common postpartum problem, affecting up to 10% of women who give birth

12. Causes Predisposing factors Aggravating factors Grand multipara

13. Grand multiparity Over distension of uterus.
Maternal ill health
Caesarean section Prolase of the uterus Uteria Fibroid Retroversion after the uterus become pelvic organ A. Predisposing factors Over distension of uterus.

14. Uterian fibroid

15. B. Aggravating factors - 1. Retained products of conception . 2. Uterian sepsis ( endometritis ).

16. Symptoms The condition may be asymptomatic . The predominant symptoms are- 1. Abnormal lochial discharge (excessive or prolonged ) 2. Irregular or at times excessive Uterine bleeding . 3. Irregular cramps like pain . 4. In case of retained products rise of temperature.

17. Signs The uterian height is greater than the normal. Normal puerperal uterus may be displaced by a full bladder or a loaded rectum It feels boggy and softer. Presence of features responsible for subinvolution may be evident

18. Fundal height greater than postnatal day Displaced bladder or loaded rectum Uterus feels boggy and softer

19. Investigation History collection Physical examination ( Fundal height ) Lochial discharge Laboratory reports Ultrasonography

20. MANAGEMENT MEDICAL TREATMENT Administration of oxytocin medication to improve uterian muscle tone. Oxytocin medication includes- methargin doc since it can be given by mouth. Dilation and curettage (D&C) to remany retained fragments. Antibiotics therapy for endometritis . Pessary in prolapse or retroversion.

21. Strategies for improving uterine involution Provide Balanced diet Careful Surveillance and assistance at the time of calving Prevention of postpartum diseases Early diagnosis and treatment of postpartum uterine abnormalities

22. NURSING INTERVENTIONS History collection Physical examination Early ambulation post partum Daily evaluation of fundal height Taking vitals daily and regularly. To give medications properly on time. Record and reporting.

23. Complications Some of the possible complications of subinvolution of uterus include heavy or prolonged bleeding, infection, pelvic pain, infertility. In some cases, subinvolution of uterus can lead to the formation of uterine fibroids or the development of endometriosis . These conditions can cause further complications such as painful periods, heavy bleeding, and difficulty getting pregnant. Subinvolution of uterus can also lead to the formation of scar tissue or adhesions, which can cause chronic pain and discomfort.

24. Reference D.C.Dutta , Textbook of obstetrics. 7 th ed. London, New Central Book Agency (P)Ltd;2011. Page no – 410 Annamma J. A comprehensive textbook of midwifery. 2 nd ed. Jaypee Brother Medical publisher. Page no.449 Nima Bhaskar , midwifery and obstetrics nursing, 2 nd edition EMMESS medical publisher. Page no. 565-66

25. Internet References https://www.slideshare.net/slideshow/subinvolution-of-the-uterus/232092717 https://www.slideshare.net/slideshow/subinvolution-. 117453988/117453988 https://www.thenursepage.com/subinvolution-of-uterus/#5_Complications_Associated_with_Subinvolution_of_Uterus