Subinvolution

Question 1

What is subinvolution?

Answer 1

Subinvolution is when the involution is impaired or retarded, particularly affecting the uterus, which is the most common organ involved.

Question 2

What are the predisposing factors for subinvolution?

Answer 2

The predisposing factors include: (1) Grand multiparity; (2) Overdistension of uterus (e.g., twins, hydramnios); (3) Cesarean section; (4) Uterine prolapse; (5) Retroversion of the uterus; (6) Uterine fibroids.

Question 3

What are the aggravating factors for subinvolution?

Answer 3

Aggravating factors include: (1) Retained products of conception; (2) Uterine sepsis (endometritis).

Question 4

What are the symptoms of subinvolution?

Answer 4

Symptoms may be asymptomatic, but predominant symptoms include: (1) Abnormal lochial discharge (excessive or prolonged); (2) Irregular or excessive uterine bleeding; (3) Irregular cramp-like pain or rise of temperature in sepsis.

Question 5

What signs indicate subinvolution?

Answer 5

Signs include: (1) Uterine height greater than normal for the puerperium day; (2) A boggy and softer uterus; (3) Presence of features responsible for subinvolution.

Question 6

How is subinvolution managed?

Answer 6

Management involves ignoring the size of the uterus if there are no excessive lochia, irregular bleeding, or sepsis. Treatment is initiated only for local pathology, such as: (1) Antibiotics for endometritis; (2) Exploration for retained products; (3) Pessary for prolapse or retroversion.

Question 7

Is Methergine effective for subinvolution?

Answer 7

Methergine is often prescribed to enhance the involution process but is of little value in prophylaxis.