Subinvolution is a condition where the uterus fails to return back to its normal size following childbirth and is the main cause of secondary postpartum haemorrhage.
Normal uterine involution should follow a progressive pattern that demonstrates the reduction in uterine size in the days following the birth until the uterus is no longer palpable abdominally.
Subinvolution of the implantation site is a significant contributor to delayed postpartum hemorrhage (PPH).
If you are feeling unwell, have abdominal pain, vaginal bleeding that is brighter red or heavier than previously, passing clots or offensive vaginal discharge, may indicate subinvolution. You must talk to your doctor right away.
It’s very important to assess the uterine involution at regular intervals throughout the puerperal period during postnatal visits.
What causes subinvolution?
Many factors that cause subinvolution are-
- Overdistension of the uterus due to twin pregnancy or polyhydramnios
- Caesarean section
- Prolapse of the uterus
- Uterine fibroids
- Uterine infections
- Ill health of the mother
- Grandmultipara
- Retained products of conception
- Retroversion after uterus becomes a pelvic organ
What are the signs and symptoms of subinvolution?
The condition may be asymptomatic but some of the predominant signs and symptoms are
- Normal lochia discharge either excessive or prolonged
- In the case of retained products, a regular cramp-like pain occurs
- Rise of temperature in case of infection
- Irregular bleeding or at times excessive uterine bleeding
- The uterine height is more than the normal for the particular day of puerperium
- Uterus feels boggy and softer.
How is subinvolution treated?
Women with subinvolution of the uterus are treated symptomatically. In case of any infection, antibiotic therapy is started.
Oral methergine tablet is given to enhance the process of involution and reduce bleeding. If subinvolution is caused due to retained products then exploration of the uterus is done to remove the afterbirths and retained tissues.
In prolapse or retroversion of the uterus, a pessary can be inserted to support the structures. Uterine drainage followed by early ambulation should be encouraged.
Conclusion
In the above post, we have discussed the subinvolution. It is a condition in which the uterus fails to return back to its normal size following the birth of the baby. The uterus height is more than normal for the particular day of the puerperium and feels softer; requires treatment for the underlying causes.
