Subinvolution

Definition: When the involution is impaired or retarded, it is called subinvolution. The uterus is the most common organ affected in 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.

When the involution is impaired or retarded it is called subinvolution. The uterus is the most common organ affected by subinvolution.

Causes: Predisposing factors are

👉 Grand multiparity,

👉 Overdistension of uterus as in twins and hydramnios,

👉 Maternal ill-health,

👉 Cesarean section,

👉Prolapse of the uterus,

👉Retroversion after the uterus becomes pelvic organ,

👉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 in 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.

✍️ Presence of features responsible for subinvolution may be evident.

ManageMent: Mere size of the uterus is not important and provided there is absence of features, such as excessive lochia or irregular bleeding or sepsis, the size of the uterus can be safely ignored. Appropriate therapy is to be instituted only when subinvolution is found to be a mere sign of some local pathology:

✍️Antibiotics in endometritis,

✍️ Exploration of the uterus in retained products,

✍️  Pessary in prolapse or retroversion. Methergine, so often prescribed to enhance the involution process, is of little value in prophylaxis.

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