Everything you need to know about uterine subinvolution

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Doctors call the time after childbirth the tenth month of pregnancy. Indeed, no matter how much one would like it, nothing ends with childbirth. Afterwards, a new round of organ development begins. After the birth of a baby, reverse processes occur in a woman’s body. The volume of progesterone decreases, the uterus contracts. It is during this postpartum period that a pathology called uterine subinvolution may occur. What is it and how can you resist it? Let's look at all these questions.

What is uterine subinvolution?

This phenomenon is usually observed in mothers immediately after childbirth. Subinvolution is a slow process of recovery after the birth of a child. This can occur due to viral processes or mechanical damage. That is, if a woman’s uterus does not contract to normal size within the allotted time, then she has subinvolution of the organ.

Usually the uterus returns to its normal position after 2 months. The fact that this process has not started in a woman can be understood already a week after giving birth, or even earlier.

Causes

The reasons for the development of subinvolution are divided into two groups. The first group is an infectious factor in the development of pathology. It includes the following manifestations:

• Inflammatory processes inside the womb;
• Infection in the uterine cavity during the birth process;
• Development of infection against the background of chronic diseases such as pyelonephritis, anemia, inflammation of the appendages;
• Residual effects of the presence of the placenta in the pelvic organs;
• The presence of sexually transmitted diseases in a woman’s body.

If the infection is in the cervix, then this is already enough for the development of subinvolution. However, if the same infection enters the organ itself, then subinvolution develops in a rather acute form.

The second group of reasons is called true. It includes mechanical damage to the uterus caused by one or another phenomenon. For example:

• With a large fetus, stretching of the organ may develop (with multiple pregnancy and polyhydramnios);
• If the birth took place quickly;
• If on the contrary, the birth was very long;
• If there is a tumor in the uterus before pregnancy;
• Physical passivity after childbirth;
• If in the last months of pregnancy a woman suffered from toxicosis;
• Childbirth at a dangerous age: too early, or late birth.

A separate reason for the development of subinvolution is the consequence of cesarean section. Due to the operation, stitches remain in the uterus. Therefore, if a woman in labor has a problem with suture healing, then she cannot avoid uterine subinvolution. The scar simply will not allow the muscle to fall back into place.

Risk factors

At risk are those mothers who, before pregnancy, suffered from diseases that contribute to the development of postpartum subinvolution of the uterus.

• Diabetes type 1 and 2;
• Obesity;
• Disease of the endocrine system;
• Vegetative-vascular dystonia;
• Varicose veins

It also affects the development of pathology of gynecological diseases:

• Anemia;
• Colpitis;
• Herpes;
• Ruptures of the cervix, vagina.

Doctors often underestimate the problem of subinvolution, which is why women have severe complications. According to statistics, 2-10% of women who are not at risk suffer from this pathology. Women who have an infection in the birth canal suffer from subinvolution in 20% of cases. And those who give birth by cesarean section suffer from subinvolution in almost 35% of cases.

Symptoms and signs

Often this pathology is painless. However, following a number of warnings, a woman will not ignore the symptoms of the disease. After giving birth, you should go to the doctor if you suspect subinvolution with the following symptoms:

• Bloody discharge. If the discharge becomes dark or foul-smelling, this is a reason to consult a doctor.
• If after 3 weeks the blood has not decreased, this is a sign of uterine subinvolution.
• The inflammatory process is usually accompanied by fever. If a woman does not have a cold, does not have problems with her breasts when feeding, but her temperature has risen, then it is worth going to the doctor to check whether the uterus is contracting correctly.
• Usually, when the organ returns to its normal position, the woman feels slight contractions in the lower abdomen. This indicates contraction of the uterus. If she doesn’t feel this when breastfeeding and just walking, it means that most likely the uterus is not contracting to the desired size.

A woman can notice all these symptoms herself. Don't put off visiting your doctor. The sooner you start dealing with the problem, the faster you can fix it.

Diagnostics

After contacting a doctor with the above symptoms, the woman will undergo a series of examinations.

• Diagnosis of subinvolution begins with an examination in a gynecological chair. In addition to discharge, the doctor will find a loose uterus. On palpation, the woman will experience pain. The organ itself will be slightly open to the width of 1-2 fingers, and clots will be observed in the cavity. So, with subinvolution of the uterus, the organ is enlarged, loose and located below the required level. In some cases, bending is possible.
• ultrasound. After a preliminary diagnosis during examination, the doctor must confirm the diagnosis using an ultrasound examination. When examined on the screen, the doctor will see that the size is not normal. There is blood in the lochia, and the cervix is ​​narrowed. The muscle layer that is responsible for pregnancy is preserved. What is the norm? See the table for the size (mm) of the uterus immediately after birth.

Deviations from the norm indicate that the uterus is not contracting at the rate it should.

• Hysteroscopy. This method is rarely used after childbirth. There must be strong indicators for this operation. During hysteroscopy, the condition of the uterus is examined by inserting a tube with a camera and manipulators into the peritoneum. This diagnostic method will allow you not only to examine the condition of the organ, but also to take the contents of the cavity for analysis.

Treatment

Treatment of this pathology should be aimed at eliminating the cause that caused it. If subinvolution has a viral etiology, then the group of drugs will be determined based on the virus. Below are the most popular medications used for treatment.

• Antibiotics that eliminate inflammation in the pelvic organs. When taking these drugs, the patient should stop breastfeeding and express and discard milk. Prescribe drugs such as Gentamicin intramuscularly 3 mg 2 times a day for a week. Sumamed 1 tablet per day for 5 days.
• To eliminate congestion, blood thinning drugs are prescribed. Cardiomagnyl 2 tablets twice a day.
• In order to stimulate contraction of the muscles of the uterus, a woman is prescribed the drug oxytocin. It is usually administered as a dropper. Normally, the uterus will shrink by 1 cm per week.
• There are also a number of drugs that help cleanse lochia and eliminate bleeding. This group of drugs is rarely prescribed, as it has a bad effect on lactation. These are tablets Ertogal, Parlodel, Methylergometrine. Half a tablet 2-3 times a day. The duration is prescribed by the doctor.
• Physiotherapy. This method involves using natural resources to increase the contractility of the organ. Use:

1. A magnetic field;
2. Laser;
3. Ultrasound.

electrophoresis

The doctor will prescribe the method for this type of therapy individually. On average, you need to attend the procedures 10 times and combine them with taking medications.

Forecast

The prognosis for treatment of subinvolution is quite comforting. If you correctly follow the doctor's instructions and timely detection, a woman will be able to overcome the pathology, and her uterus will return to its normal size.

Consequences and complications

There are two most serious complications of this pathology:

• Infertility. Inflammation in the organ has a bad effect on reproductive function.
• Gynecological diseases. Often, subinvolution of the uterus, which is not treated, leads to fibroids, hyperplasia, and endometriosis.

So, consult a doctor in time if you notice that your uterus is not contracting, and then you can avoid serious consequences.

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