Differential diagnosis and treatment of uterine subinvolution
Uterine involution is a physiological process during which the reverse development of the uterus occurs. Subinvolution is a pathology accompanied by a delay in the recovery of the normal size of the reproductive organ. The main signs of subinvolution of the uterus are copious brown discharge, subfebrile temperature, absence of cramp-like pain during feeding. Specialists consider this condition to be an independent disease, the cause of which is an infection. Without proper treatment, subinvolution can be complicated by endometritis.
Reasons of postpartum subinvolution of the uterus:
- big fruit, multifertility;
- rapid (prolonged) childbirth;
- myoma of the uterus;
- anatomical features;
- infection.
In addition, subinvolution of the uterus after childbirth can be caused by severe chronic diseases (tuberculosis, diabetes, thyroid gland pathology), a woman's age (older than 40 years and younger than 18), connective tissue diseases, and general exhaustion of the body.
Classification
Depending on the cause, experts distinguish primary and infectious types of the disease.
Primary is rare and is divided into:
- myogenic - most often diagnosed with polyhydramnios and rapid (prolonged) childbirth. The reason is the weakness of the myometrium;
- microcircular – a consequence of late gestosis. The reason is swelling of the tissues and slow recovery of the blood network of the uterus;
- endocrine - due to pathology of the endocrine system and lack of breastfeeding.
The infectious type is caused by viral (bacterial) pathogens, including opportunistic flora. The risk of developing complications increases significantly in the presence of an infection in the body and in the presence of residual waste in the uterus.
During the consultation, the doctor will give clinical recommendations for subinvolution of the uterus after cesarean section and will answer your questions. Registration on our website Dobrobut.com and by phone.
Symptoms of uterine subinvolution after childbirth
The main symptom is the presence of abundant brown bloody discharge within three weeks after childbirth. A woman may also complain of profuse sweating, chills, and low-grade fever. Doctors consider the absence of cramp-like pain during breastfeeding to be an indirect symptom of uterine subinvolution after childbirth.
The infectious type of subinvolution of the uterus is more difficult. Clinical manifestations - abundant purulent secretions, tachycardia, chills, elevated temperature, pain in the lower abdomen, symptoms of general intoxication.
Complications:
- endometritis, endomyometritis;
- peritonitis;
- sepsis, septic shock;
- metrothrombophlebitis;
- uterine bleeding.
The doctor will tell you about the features of subinvolution of the uterus after an abortion at the appointment.
Diagnostics
Doctors identify a risk group - women most prone to the development of subinvolution. Special attention is paid to pregnant women with polyhydramnios and a large fetus, with fibroids and late gestosis, with infectious and inflammatory diseases of the genitourinary system.
The diagnosis is made after examination of the woman in a chair, ultrasound, MRI of the pelvic organs and hysteroscopy. For suspicion of an infectious type, a general analysis of blood and urine, as well as culture of microflora to determine the causative agent, must be prescribed. It is extremely important to differentiate uterine subinvolution from pelvioperitonitis and appendicitis.
Is oxytocin appropriate for uterine subinvolution
Treatment of pathology should be comprehensive. In addition to medicines, experts recommend special massage and instrumental methods.
Treatment scheme:
- antibiotics and hormones;
- general strengthening therapy;
- gynecological massage;
- instrumental removal of blood clots and individual inclusions.
In addition, the woman is recommended bed rest, absence of emotional and physical stress. Regular attachment of the baby to the breast will also help shorten the myometrium.
Oxytocin in subinvolution of the uterus plays an important role, promotes faster contraction of the uterus, stops bleeding after childbirth and restores the contractile activity of the uterus.
Prevention and prognosis
The prevention of subinvolution of the uterus consists in performing special exercises during pregnancy that contribute to the effective contraction of the uterus, in the timely treatment of chronic diseases of the genitourinary system, rational nutrition and weight control. Obstetricians and gynecologists prescribe hormonal drugs to accelerate involution in the first days after childbirth for women who are at risk.
If you need specialist advice, make an appointment. Doctors of the highest category with many years of experience work in the center.
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Gynecological consultation
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