Involution Of Uterus – This course is designed to understand the care of pregnant women and newborn: antenatal, intra-natal and postnatal; breast feeding, family planning, newborn care and ethical issues, The aim of the course is to acquire knowledge and develop competencies regarding midwifery, complicated labour and newborn care including family planning.
Involution Of Uterus
Involution of uterus
Involution is the process whereby the uterus revert back approximately to the state as they were before pregnancy.
Size of uterus
- Just after delivery: (At the level of umbilicus) 24 weeks of gestation.
- First 24 hours of delivery: No involution occur.
- After 24 hours 1.25 cm of uterus is reduced.
- Midpoint between umbilicus & pubic syumphysis-16 weeks of gestation.
- At the level of pubic simphysis-12 weeks of gestation (becomes pelvic organ).
Sub-involution
When the involution of uterus is impaired or retarded, it is called sub-involution of uterus.
Causes of sub-involution
A. Predisposing factors –
- Grand multiparity:
- Over distension of uterus (Twins, hydramnios).
- Maternal ill health.
- Cesarean section.
- Prolapse of the uterus.
- Retroversion after the uterus becomes pelvic organ.
- Uterine fibroid.
B. Aggravating factors:
- Retained products of conception.
- Uterine sepsis (endometritis).
4 important urinary complications of puerperium:
- Urinary tract infection (U11).
- Retention of urine.
- Incontinence of urine.
- Suppression of urine.
4 important organisms for UTI:
- E. coli
- Klebsiella.
- Proteus.
- Staphylo coccus aureus.
Birth injury
The Ten Most Common Birth Injuries:
1. Brachial Plexus Injuries (BPI).
2. Bone Fractures.
3. Cephalohematoma.
4. Caput Succedaneum.
5. Perinatal Asphyxia.
6. Intracranial Hemorrhage/Subarachnoid Hemorrhage.
7. Subconjunctival Hemorrhage.
8. Facial Paralysis.
9. Spinal Cord Injurie.
10. Cerebral Palsy.
Common injuries occur in pelvic organ following child birth
- Laceration of vulval skin.
- Perineal tear.
- Vagina tear or lacerations.
- Cervix tear.
- Pelvic haematoma/vulval haematoma.
- Rupture uterus.
Vulval haematoma:
Collection of blood anywhere in the area between the pelvic peritoneum and the perineal skin is called pelvic haematoma.
Anatomical types:
Depending upon the location of the haematoma, whether below or above the levatorani, it is termed as:
- Infralevatorhaematoma-common.
- Supralevatorhaematoma(rare).
(Infra levatorhaematoma is the commonest vulvalhaernatoma).
Causes of vulval haematoma
- Improper haemostasis during repair of vaginal or perineal tears or episiotomy wound- Failure to take precaution while suturing the apex of the tear. Failure to obliterate the dead space while suturing the vaginal walls.
- Rupture of pervaginal venous plexus either spontaneously or following instrumental delivery.
Symptoms of vulval haematoma
- Persistent, severe pain on the perineal region & fever.
- There may be rectal tenesmus or bearing down efforts when extension occurs to the ischiorectal fossa. There may be even retention of urine.
Signs of vulval haematoma
- Variable degrees of shock may be evident.
- Local examination reveals a tense swelling at the vulva which becomes dusky and purple in colour and tender to touch.”
Treatment of vulval haematoma
- A small haeroatóma (>5 cm) may be treated conservatively with cold compress.
- Larger haematoma should be explored in the operation theatre under general anesthesia. Simultaneous resuscitative measures are to be taken.
- The blood clots are to be scooped out and the bleeding points are to be secured.
- The dead space is to be obliterated by deep mattress sutures and a closed suction drain may be kept in that place for 24 hours.
- Prophylactic antibiotic is to be administered.
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