Subinvolution

Subinvolution is a medical condition in which after childbirth, the uterus does not return to its normal size. Definition When the involution is impaired or retarded it is called subinvolution.The uterus is the most common organ affected by subinvolution.As it is the most accessible organ to be measured per abdomen, the uterine involution is considered clinically as an index to assess subinvolution.

Causes

Predisposing factors are

a. grand mutiparity,

b. overdistension of uterus as in twins and hydramnios

c. maternal ill health,

d. caesarean section

e. Prolapse of the uterus

f. retroversion after the uterus becomes pelvic organ

g. uterine fibroid

Aggravating factors are:

• Retained products of conception
• Uterine sepsis, endometritis

Symptoms

The condition may be asymptomatic. The predominant symptoms are:

• Abnormal lochial discharge either excessive or prolonged
• Irregular or at times excessive uterine bleeding
• Irregular cramp like pain is cases of retained products or rise of temperature in sepsis

Signs

The uterine height is greater than the normal for the particular day of puerperium. Normal puerperal uterus may be displaced by a full bladder or a loaded rectum. It feels boggy and softer.

Management

• Antibiotics in endometritis
• Exploration of the uterus in retained products
• Ergometrine so often prescribed to enhance the involution process by reducing the blood flow of the uterus is of no value in prophylaxis.

Factors that may cause subinvolution

• Persistent lochia/fresh bleeding
• Long labor, anaesthesia, full bladder, difficult delivery, retained placenta, infection

References

• DC Dutta Text book of obstetrics sixth edition