Causes, main symptoms and treatment of subinvolution of the uterus. Involution of the genital organs during menopause Possible causes and characteristic symptoms

Subinvolution of the uterus

Subinvolution of the uterus - a delay in the process of reverse development of the uterus after childbirth, caused by viral or mechanical damage. In this pathological condition, the uterus cannot shrink to its natural prenatal size. This phenomenon refers to postpartum complications.

Causes

Causes of subinvolution of the uterus include:

• Retention of parts of the placenta or membranes in the uterine cavity
• Multiple pregnancy or large fruit
• Polyhydramnios
• Rapid or prolonged labor
• Childbirth by caesarean section
• uterine fibroids
• The presence of inflammatory processes in a woman during pregnancy, accompanied by pyelonephritis and anemia
• Infection during childbirth

Symptoms of subinvolution of the uterus

The first symptom of subinvolution of the uterus is incessant brown bleeding. On examination, the gynecologist notes that the uterus is enlarged, has an insufficiently dense consistency, and the rate of its contraction is slowed down. Sometimes there is a slight increase in body temperature (37-37.5o) for a long time. This indicates the presence of a sluggish inflammatory process in the body.

Another symptom is the absence of the usual postpartum cramping pains in the lower abdomen, including during breastfeeding.

Diagnostics

The diagnosis of subinvolution of the uterus is made on the basis of the clinical symptoms of this complication, according to the characteristic state of the uterus in comparison with the norm for a given postpartum day. Examination methods include examination using mirrors, bimanual examination, and ultrasound scanning. Ultrasound provides an objective assessment of the size of the uterus, which allows timely diagnosis of subinvolution.

Sonography is used to determine the presence of pathological inclusions in the uterine cavity. This is necessary for the choice of treatment tactics.

Types of disease

Depending on the cause of occurrence, the following types of subinvolution of the uterus are distinguished - infectious and true.

Subinvolution of an infectious nature is caused by inflammatory processes after childbirth against the background of pyelonephritis and anemia of pregnant women. The infection can be introduced during childbirth. Also, inflammation occurs when the remnants of the placenta and fetal membranes are retained in the uterine cavity.

True subinvolution is caused by mechanical overstretching of the uterus, or cervical fibroids, adenomyosis.

Patient's actions

If persistent heavy brown bleeding occurs after childbirth, the woman must report this symptom to the obstetrician.

If symptoms occur after discharge from the hospital, you should not postpone going to the gynecologist.

Treatment of subinvolution of the uterus

Treatment of uterine subinvolution depends on the type and clinical course. If subinvolution is accompanied by an inflammatory process, then it is an independent disease, for the treatment of which antibiotics are used. If an infection is detected, in addition to antibiotics, drugs are prescribed that thin the blood and improve blood circulation in the uterus. The treatment period is usually 7-10 days.

For the treatment of true subinvolution, drugs that stimulate muscle tone are prescribed. In the absence of intoxication, blood clots are removed from the uterine cavity with a vacuum pump. Cold saline solution is used to flush out lochia from the vagina. As a local treatment, rectal massage of the uterus and ovaries can be prescribed.

In the presence of a virus, the use of the method of intramuscular injection of ergot, oxytocin, sinestrol, or colostrum preparations is likely. Effective therapy is novocaine and autohemotherapy.

Neofur, metromax, hysteroton, exuter or furazolidone sticks are administered intrauterinely, a glucose solution with ascorbic acid is administered intravenously.

Complications

As a result of subinvolution of the uterus, postoperative endometritis, stagnation of lochia and the development of infection may occur.

Prevention of subinvolution of the uterus

Prevention of subinvolution of the uterus is carried out at the stage of pregnancy planning. It consists in performing a set of Kegel exercises, which contribute to a good contraction of the uterus and allow you to restore its normal size from a stretched state.

The process of involution (reverse development) of the uterus occurs quickly. As a result of the contractile activity of the muscles, the size of the uterus decreases. The degree of contraction of the uterus can be judged by the level of standing of its bottom. During the first 10-12 days after childbirth, the bottom of the uterus drops by about 1 cm daily. overflow of the bladder - above the navel.

Measurement with a centimeter tape shows that on the 2nd day the bottom of the uterus is located 12-15 cm above the pubic junction, on the 4th day - 9-11 cm, on the 6th day - 9-10 cm, on the 8th - by 7 - 8 cm, on the 10th - by 5 - 6 cm or at the level of the pubis. By the end of the 6th - 8th week after birth, the size of the uterus corresponds to the size of the non-pregnant uterus (in lactating women it may even be smaller).

By the end of the first week, the mass of the uterus decreases by more than half (350-400 g), and by the end of the postpartum period it is 50-60 g. The internal os and cervical canal are also quickly formed. If immediately after childbirth, the internal os was passable for the hand, then after 24 hours it passes two fingers, and after 3 days it is barely passable for one finger.

The formation of the pharynx occurs due to the contraction of the circular muscles surrounding the internal opening of the cervical canal. By the 10th day after birth, the canal is fully formed, but the external pharynx is passed even for the tip of the finger. The closure of the external os is completed completely on the 3rd week after birth, and it acquires a slit-like shape.

Thus, the formation of the cervix and its canal occurs from top to bottom. As a result of the contraction of the uterus and the circular muscles located around the internal os, the border between the upper and lower segments of the uterus is indicated.

Its bottom in the first days of the postpartum period comes into contact with the inner surface of the abdominal wall, an angle is formed between the body and the cervix, open anteriorly (anteflexio uteri). In the following days, the bottom of the uterus often deviates backwards, which is facilitated by the relaxation of the ligamentous apparatus and the lying of the puerperal on her back.

"Obstetrics", V.I.Bodyazhyna

Menopause is the period in every woman's life when her ovaries lose their reproductive function. This usually happens between the ages of 45 and 55. In some exceptional cases, a woman's menopause may begin at age 30 or even younger. This condition is called premature menopause or premature ovarian failure.

Causes of changes during menopause

Menopause, and consequently, involutive changes in the genital organs, occur under the influence of hormonal changes. During a woman's reproductive years, a woman's ability to produce eggs each month is tied to the production of the three sex hormones estradiol, estrone, and estriol, collectively referred to as estrogen. It is mainly produced by the ovaries, although small amounts are also found in the adrenal glands and placenta of a pregnant woman.

Estrogen is responsible for changes in a woman's body during puberty and controls a woman's reproductive cycle: the maturation and release of an egg each month (ovulation) and the thickening of the uterine wall to accept a fertilized egg. Menstruation occurs because pregnancy does not occur, implantation of a fertilized egg does not occur, and the uterine mucosa is updated.

As women get older, the number of eggs in the ovaries decreases and their ability to conceive decreases. At this time, less estrogen begins to be produced, as a result of which the body begins to respond to changes in hormonal levels. However, the body does not stop producing estrogen overnight, and the rebuilding process can even take several years, during which menopause symptoms occur gradually. This gradual change is called perimenopause.

Around the age of 50-55 years, the monthly cycle stops completely, ovulation does not occur, there are no periods. This is menopause.

Many women experience this period deeply, for each it is a personal experience, and not just a medical condition. Decreased levels of estrogen produced by the ovaries are often the cause of symptoms that require medical attention.

All of the common symptoms of menopause are associated with a decrease in the production of estrogen in the body. The lack of a sufficient amount of it in the body affects the entire body as a whole, including the brain, causing changes in the emotional nature, as well as having a significant effect on the skin, its elasticity and thickness.

Once the ovaries stop producing estrogen, there are many changes in the body that affect long-term health. Most often, these changes relate to bone strength and density, increasing the risk of bone thinning that causes osteoporosis. The bones of the female skeleton depend on estrogen to keep them strong and resistant to breakage.

There are a number of studies that prove that estrogen deficiency is the cause of some chemical changes in the body. These changes increase vulnerability to heart disease and stroke.

The introduction of modern diagnostic methods (ultrasound, hysteroscopy, tomography, dopplerography) helped doctors get a more accurate assessment of the condition of the uterus and ovaries in the postmenopausal period.

Uterus and ovaries with menopause

Due to changes in the hormonal background, the uterus, as the organ that is most susceptible to the influence of female hormones, decreases in volume up to 40%. This is due to ongoing atrophic processes in the myometrium. The most significant involutive changes occur within two years of postmenopause, then the process stops, and a further decrease in the volume of the uterus does not occur.

At the initial stage of postmenopause, ultrasound does not show significant changes. With an increase in the period of absence of menstruation, multiple hypoechoic areas begin to appear, corresponding to fibrosis of the myometrium.

Doppler study shows a significant decrease in blood flow in the myometrium, which is characteristic of this period. Myoma nodules, which often develop during the premenopausal period without adequate nutrition and in the absence of sufficient hormonal support, also undergo a process of atrophy - their diameter decreases. Moreover, seals with initially high echo density - fibromas - are subject to minor changes, and seals with medium or low echogenicity - leiomyomas - almost disappear.

With a submucosal (directed towards the uterine cavity) location of benign neoplasms, bleeding may occur. Ultrasound examination does not give a complete picture of the causes of bleeding - it is a submucosal node or concomitant pathologies of the uterine mucosa. Diagnosis is best confirmed by the results of hydrosonography and hysteroscopy.

If the diagnosis shows an increase in the volume of the uterus and myomatous seals during menopause, in such cases it is necessary to exclude the development of hormone-producing pathology in the ovaries or uterine cancer. It is worth noting that uterine sarcoma is an extremely rare disease of this period. And the risk factors for its occurrence are not fully understood.

The internal mucous membrane of the uterus during the period of extinction of the reproductive function ceases to be updated monthly and gradually atrophies. Involutive processes that affect the uterus as a whole cause a significant decrease in its volume. On ultrasound, a reduction in the anteroposterior size of the M-echo to 4-5 cm is clearly seen, the echogenicity of this area increases.

Sometimes the processes of involution of the uterine mucosa can contribute to the creation of synechia, which can be diagnosed by ultrasound or hysteroscopy. The retention of a certain amount of fluid in the uterine cavity, which can be detected by sagittal scanning, is not a sign of the disease and occurs as a result of the fact that the cervical canal narrows and the outflow of the contents of the uterine cavity deteriorates.

The size and shape of the ovaries undergo significant fluctuations depending on the individual characteristics of each woman, and this explains the disparity in the level of sex hormones produced during this period.

With ovarian atrophy, ultrasound can detect their significant change in volume, sound conductivity decreases, and hyperechoic areas are traced. On Doppler examination, there is no clear boundary of the ovaries.

With the hyperplastic type of ovaries, the reduction in the volume of the organ occurs more slowly, androgen production is largely preserved. This is a sign that now the main producer of hormones is not the follicular apparatus, but the stroma of the ovaries.

When screening diagnostics in women without concomitant complaints, the frequency of detected ovarian diseases is 4%. Among the tumors found in women, ovarian cancer ranks second. In postmenopause, it is especially important to pay attention to various deviations in the health of the uterine appendages, since it is during this period that the risk of developing malignant tumors increases.

This disease is especially insidious in that in 72% of cases its asymptomatic course is observed. It is also difficult to detect ovarian pathology in a timely manner due to concomitant age-related diseases: obesity, prolapse of the genital organs, adhesive processes of the uterus and appendages.

Often, pathological processes in the ovaries are accompanied by diseases of the endometrium. In a third of patients, one or another form of damage to the internal mucous membrane of the walls of the uterus is found: polyps, endometrial dysplasia.

A highly informative way to control ovarian involution in the postmenstrual period is considered to be transabdominal and transvaginal ultrasound.

In the postpartum period, the uterus and other genital organs return to normal. This process is called involution. Postpartum subinvolution of the uterus is a complication that is characterized by a slow contraction of the organ and the cleansing of its internal cavity. According to ICD X, such a pathology is referred to as code O90.89 - "other complications of the postpartum period, not classified elsewhere." In most cases, the condition is not an independent disease, but serves as the first sign of a postpartum infection (endometritis).

Normal uterine involution

Immediately after childbirth, the upper uterine border lies about 5 centimeters above the pubic symphysis (the upper edge of the pubic bones), approximately at the level of the umbilicus.

The rate of involution is maximum in the first five days (about 1 cm per day) of the postpartum period and then gradually slows down. By the 7th day, the uterus becomes much smaller, and its upper border is located at the level of the symphysis. She restores the size that was before pregnancy, 6 weeks after childbirth.

Involution is accompanied by lochia - thick vaginal discharge, consisting of endometrial remnants. When this process slows down, they speak of uterine subinvolution. Pathology is recorded in 1% of cases, and among all complications of the postpartum period, it is half.

Causes of the pathological condition

Subinvolution of the uterus after childbirth can be due to such reasons:

• C-section;
• , accompanied by excessive stretching of muscle fibers;
• retention of parts of the placenta in the uterine cavity after childbirth, these fragments can also become the site of infection and the formation of postpartum endometritis;
• prolonged or rapid labor, depleting the contractility of the myometrium;
• secondary infection - endometritis.

More often than others, the disorder occurs in puerperas with fibromyoma, women younger than 18 or older than 40 years, in the absence of lactation, especially in the first days after childbirth. Also, diseases such as posthemorrhagic anemia, connective tissue diseases, abnormalities in the development of the uterus, digestive disorders with malabsorption syndrome, malnutrition, and severe chronic diseases, including tuberculosis, contribute to the weakening of the body and, as a result, to slowing down recovery.

Subinvolution of the uterus after caesarean section is not a pathological, but a physiological process. It is associated with delayed contraction and healing of the dissected muscles of the uterine wall. In this case, it is not recommended to use Oxytocin, therefore, antibiotics are prescribed without fail to prevent infectious complications.

Sometimes there is a false subinvolution if the measurement of the organ is performed with incomplete emptying of the bladder. Therefore, in the postpartum period, before a medical examination, you should urinate.

Currently, the main theory of the development of subinvolution of the uterus is infectious. Normally, it should decrease on its own, even in the presence of adverse factors. Subinvolution is considered as a risk factor or the first manifestation.

Pathogenesis

In the development of postpartum uterine subinvolution and the addition of endometritis, three factors of pathogenesis are of primary importance:

1. Insufficient hormonal and nerve stimulation of the uterine muscle fibers

It leads to their overstretching and violation of contractility (ability to contract). An increase in intercellular spaces between stretched muscle fibers increases the area and depth of penetration of pathogens, which contributes to the development of infection.

1. Insufficient spasm of uterine vessels in the first days after childbirth

It causes swelling of tissues, their inflammation and the absence of normal contraction of the organ. The reason for this is foreign bodies in the uterine cavity (remnants of the endometrium). For example, this is how the subinvolution of the uterus develops after an abortion. Therefore, such a procedure is recommended to be performed by a qualified doctor with careful ultrasound control after it.

1. Tissue edema

It contributes to impaired blood supply, which slows down the physiological breakdown of connective tissue fibers located between muscle cells and preventing their normal size from returning.

Kinds

The division of subinvolution of the uterus into types is based on infection of the endometrium that occurred after childbirth. Therefore, there are primary and secondary types.

The primary type develops in the complete absence of inflammatory changes. It is observed quite rarely and occurs under the influence of such factors:

• myogenic, that is, muscle weakness after multiple pregnancy, rapid or prolonged labor;
• microcirculatory, that is, a violation of the blood supply to tissues, the release of fluid into the intercellular space and edema during;
• endocrine, associated with a violation of hormonal stimulation of myometrial contraction; in particular, subinvolution's own oxytocin may not be produced due to lack of breastfeeding.

Endometritis can be caused by viruses, bacteria, including those that normally exist on the surface of the genital organs and in the intestines (opportunistically pathogenic). The likelihood of this is especially high with a delay in the placenta, urinary tract infection. In such patients, subinvolution of the myometrium after childbirth should raise the mandatory suspicion of the development of postpartum endometritis.

Clinical manifestations

The main signs of subinvolution of the uterus:

• delayed reduction in the size of the organ after childbirth;
• lochia lasting longer than 3 weeks;
• foul-smelling discharge (a sign of infection);
• lack of spasmodic sensations in the lower abdomen when breastfeeding or nipple stimulation;
• pulling pains in the lower abdomen without connection with external causes.

A long delay in postpartum discharge in the uterine cavity, or lochiometer, often causes the development of severe endometritis. This acute inflammatory process has characteristic symptoms:

• severe fever with chills, sweating, weakness;
• the allocation of lochia is not brown, but yellowish-greenish, purulent in nature, with an unpleasant odor;
• deterioration in general well-being;
• weakness, headache;
• abdominal pain.

Consequences and complications

If the treatment of subinvolution of the uterus is carried out incorrectly, it always leads to endometritis. Even in the case of a true lesion, when there is no primary infectious factor, the remaining extensive intrauterine wound surface is quickly populated by pathogens or even opportunistic microorganisms. In the future, this can provoke the development of the following serious diseases:

• sepsis, the penetration of microorganisms into the bloodstream and the formation of purulent foci in various organs;
• peritonitis, the spread of inflammation to the peritoneum with the formation of the picture "" and the need for immediate surgical intervention;
• septic shock, a rapid decrease in blood pressure, a discrepancy between the needs of the brain and the capabilities of the cardiovascular system, impaired consciousness, the development of insufficiency of vital organs (kidneys, liver, lungs, heart);
• metrothrombophlebitis, inflammation of the walls of the veins that drain blood from the genitals, with the formation of blood clots in them and the threat of their spread through the venous system and the right parts of the heart to the pulmonary vascular system, which causes a deadly condition - pulmonary embolism;
• embolism of the arteries of the genital organs, causing a sharp restriction in the flow of blood and oxygen to the tissues, which is accompanied by their ischemia and death;
• prolonged uterine bleeding, poorly amenable to hemostatic drug therapy;
• - accumulation in the uterine cavity of blood with its subsequent infection.

Thus, at first glance, a harmless slow recovery of the normal size of an organ can be the first sign of extremely serious diseases that threaten a woman's life.

Diagnostics

The risk group includes pregnant women with the following pathologies:

• excess of the normal volume of amniotic fluid;
• large or multinodular fibromyoma;
• large fruit or multiple pregnancy;
• , history of pyelonephritis;
• severe preeclampsia in the second half of pregnancy, accompanied by an increase in blood pressure, edema, the appearance of protein in the urine.

Such patients, in the absence of indications for surgery, can give birth on their own, but after the completion of the 3rd stage of labor, they require increased attention from doctors. This makes it possible to notice a too slow decrease in uterine size and associated infectious complications in time, as well as to begin their early treatment.

For the diagnosis of subinvolution of the uterus, the following methods are used:

1. Collection of complaints, physical examination, finding out the amount and nature of the discharge.
2. Gynecological examination: with a two-handed examination, an increase in the uterus is determined, which does not correspond to its normal involution, a pear-shaped or spherical shape of the organ.
3. Normally, after childbirth, the uterus should be moderately dense. Its softening may be a sign of retention in the cavity of parts of the placenta, which is the source of infection.
4. An external examination of the cervix using mirrors reveals its swelling, intense hyperemia (redness), the external pharynx is not closed, blood clots are determined in the cervical canal.
5. Ultrasound (through the abdominal wall or through the vagina) allows you to determine the true size of the organ, wall thickness, to identify the remains of the placenta in the cavity.
6. MRI of the pelvic organs is an even more informative, non-invasive, safe method.
7. - one of the most informative diagnostic methods, which even at an early stage makes it possible to determine the signs of endometritis and retained parts of the placenta.
8. In the general blood test, there may be no changes, with the development of inflammation, its nonspecific signs appear - an increase in ESR and the number of leukocytes.
9. With the development of endometritis, the material of secretions and lochia is sown on a nutrient medium. So it is possible to accurately determine the causative agent of the disease and the most appropriate antibiotic to eliminate it.

Principles of therapy

The complex of therapy includes medication, instrumental methods, as well as regimen measures and gynecological massage.

Requires bed rest, exclusion of physical activity, regular application of the newborn to the chest. If for some reason (for example, treatment with many antibiotics) the child cannot be breastfed, the mammary glands, areolas and nipples must be massaged regularly, and milk must be expressed. There is a pronounced reflex relationship between breast stimulation and myometrial contraction.

A woman should eat well. Violation of the supply of nutrients, for example, in the syndrome of malabsorption or as a result of starvation, slows down the normal involutive process.

Hormonal drugs

With subinvolution of the uterus of different genesis (after a miscarriage, abortion or childbirth), medications are prescribed that replace physiological female hormones. Oxytocin is usually used for this purpose. It is a hormone synthesized in the posterior pituitary gland. It stimulates the contractility of the uterus and increases the tone of the smooth muscles of the myometrium, leading to an acceleration of the involution of the organ. The drug is administered intramuscularly or intravenously. It is contraindicated after caesarean section and with a scar on the uterine wall. With increased contraction, accompanied by cramping pains, drugs that relax smooth muscles, for example, No-shpa, are used as an "antidote".

Methylergometrine

It acts on the vessels of the myometrium, causing their contraction, and also increases the tone of the uterine wall. The drug is administered subcutaneously or intramuscularly, it is contraindicated in kidney disease and high blood pressure.

Antibacterial therapy

Antibiotics are prescribed for the prevention and treatment of infectious complications. Usually, penicillins or cephalosporins are used. In severe endometritis, rational antibiotic therapy is based on information about the sensitivity of the isolated pathogen to chemotherapeutic agents.

Scraping

With a slow uterine contraction, blood clots remain in the organ cavity, and parts of the placenta and fetal membranes may also linger. They promote the reproduction of pathogenic microorganisms. Therefore, in most cases, a woman is prescribed vacuum aspiration of bloody contents or curettage. After scraping and removing all foreign inclusions, the myometrial wall contracts much better, and the risk of infectious complications is significantly reduced. Subsequently, it is recommended to use gynecological massage, which improves the contractility of the myometrium.

Treatment is prescribed for specific causes of subinvolution, such as tuberculosis of the reproductive system.

Prevention and prognosis

The basis for the prevention of subinvolution of the myometrium is the timely identification of risk factors. Therefore, every pregnant woman should be observed in the antenatal clinic and undergo the recommended ultrasound. With the threat of the development of pathology after childbirth, oxytocin is prescribed, and, if necessary, other drugs.

When treated at an early stage, subinvolution of the uterus does not pose a significant danger to women's health. The myometrium responds well to drug administration. Curettage while retaining parts of the placenta helps to avoid endometritis.

The most severe cases of pathology occur when the inflammatory process is running, which is accompanied by various complications described in the corresponding section.

After the birth of the baby, the mother's body begins its path to recovery, and the first thing that undergoes changes is the uterus, in which the child has been growing for all 9 months. The dynamics of the process is determined by the characteristics of delivery and the state of the body as a whole. A woman is faced with new phenomena and concepts related to the recovery period, and it is important to clearly understand what is the norm and what speaks of pathology.

Involution of the uterus after natural childbirth

Involution is the process of restoring the uterus after delivery, it lasts up to two months in the absence of complications. The impetus for the beginning of changes gives a jump in the concentration of the hormones estrogen, progesterone and oxytocin. The muscular organ, which has reached its maximum size, containing the fetus, should be reduced to the initial one - about 5 cm body and 2.5 cm neck.

After childbirth, the organ is placed atypically - at a level of 2 cm above the navel, a shift to the right or left is possible. Every day, the uterus moves a few centimeters, and a week after delivery, it almost completely descends back into the small pelvis. The weight of the stretched organ decreases, from 1 kg immediately after the baby is born to 0.5 kg in a week, 0.35 g in two weeks, etc. By the end of the recovery period, the initial weight of 50 g is restored.

The average volume of the organ after childbirth is 5 liters, and it needs to be reduced to the original 5 ml. The process of involution occurs due to the dissolution of the protein inside the endometrium, which is why the size decreases. The number of muscle cells remains unchanged. The normal size of a woman's uterus takes on average one and a half months after childbirth.

Uterus after childbirth and at the end of the recovery period

The dynamics of contraction of the neck of the organ is not as rapid as that of the body. Only at the end of two weeks, the internal pharynx closes, and the external one will restore its condition only after 3 months. At the same time, the shape of the external pharynx is not restored due to overstretching of the muscle fibers during the passage of the fetus, it takes the form of a gap, and the neck itself becomes cylindrical from conical.

postpartum discharge

After the birth of a child, his past receptacle looks like a big wound from the inside, with the greatest damage at the placenta attachment. Stopping the flow of blood after the release of the fetus occurs due to a sharp contraction of the smooth muscles of the arteries and the walls of the uterus itself. As the size of the organ decreases, the large vessels of the placenta bed are closed by blood clots, and blood clots are expelled from the cavity, the dead part of the decidua (the protective layer of the uterine mucosa), fragments of the fetal membranes, and sometimes parts of the placenta, which in general is called lochia.

The rate of discharge dynamics

Lochia is a normal phenomenon that comprehends every woman after childbirth. To assess the state of the puerperal, it is necessary to monitor their dynamics, which should have the following form:

• the first 2-3 days after delivery, the discharge is characterized as abundant, has a bright red color;
• gradually, the volume of lochia is significantly reduced, the percentage of blood decreases, and the discharge becomes brownish or yellowish. By the end of the first week, the composition of the masses expelled from the uterus is mainly the dead part of the mucous membrane of the organ and bacteria;
• the duration of the discharge is about 2 weeks, with a gradual reduction in the volume of separated masses. In women who are breastfeeding, the process can be completed faster due to the stimulation of muscle contractions by stimulation of the nipples. In some, even after 1-2 weeks, lochia can be abundant, rejection of a scab is allowed, which is formed at the site of the former placenta attachment;
• the mucous membrane of the uterus, in the absence of complications, is completely restored by the end of the third postpartum week.

Ultrasound after childbirth

Ultrasound examination of the uterus through the anterior abdominal wall is performed for all women in labor 2–3 days after the baby is born. If ruptures and bleeding are suspected, the procedure is carried out in the first hours after delivery. A diagnostic measure is necessary to assess the state of the organ. Normally, the uterine cavity at this time contains a small amount of blood and blood clots, often located in the upper part. The specialist can consider the expansion of the organ cavity, the presence of fragments of membranes in it, excessive accumulation of fluid - timely detection of such conditions helps prevent possible complications.

During the examination, the doctor evaluates the size of the organ and compares the data obtained with the tables of the norm. According to the results of ultrasound, the following violations can be detected:

• subinvolution - slowing down the recovery process of the uterus (this is evidenced by the large size of the organ relative to the norm);
• decrease in uterine tone;
• pathological changes in the uterine structure;
• the presence of clots, parts of the membranes, remnants of the placenta.

Manual examination of the uterus

After the birth of a baby for a woman, the procedures do not end. To minimize the likelihood of complications, doctors examine the condition of the organs immediately on the chair, identifying the presence of problems. The manual examination method involves inserting a doctor’s hand into the uterine cavity (immediately after childbirth, this is possible, since the opening of about 12 centimeters remains for some time) and examining the walls of the organ. The procedure is shown in the following situations:

• an obvious or doubtful violation of the integrity of the released placenta, retention of the lobules or their parts inside the uterus. Parts of the placenta remaining in the cavity and not removed in a timely manner become a source of bleeding and infection in the future;
• bleeding;
• natural childbirth with a scar on the uterus after a previous caesarean section.

Recovery of the uterus after caesarean section

The operation of caesarean section in obstetrics is performed more often than others, the procedure allows you to remove the baby directly from the uterine cavity, when natural childbirth is impossible or undesirable for medical reasons. The recovery period after such an intervention is longer, and has its own characteristics:

• immediately after the end of the operation, ice is placed on the abdomen of the woman in labor. This is necessary to stimulate the process of uterine contraction;
• discharge after delivery will necessarily be present. Through the genital tract, lochia comes out - dead particles of the endometrium, blood. Given the peculiarities of removing the baby, doctors usually immediately examine the cavity of the organ, removing the separated pieces of the placenta. The first few days of discharge are plentiful, after their volume is reduced, and the red color changes to brownish. Normally, the output of the rejected content should completely stop after 1.5–2 months;
• often in women after a cesarean section, blood clots come out. This is normal, since the mobility of the woman in labor after surgery is limited, and the liquid tissue is collected in lumps;
• restorative contractions can cause severe pain, often you have to use anesthesia.

The operation slows down the involution of the uterus, as the integrity of the muscle elements is violated in the process. Usually, the organ descends into the small pelvis only for 10–14 days, and for active restoration of size, the puerperal is prescribed drugs that stimulate contractions. If the operation went according to plan, there were no complications and additional surgical procedures, then it will take about 2 months to restore the body of the organ. Repeated pregnancy is allowed by doctors only after 2-3 years - at this time you can be sure that the internal organs have recovered and the seam is ready for loading.

The norm of the thickness of the seam after surgery

With a planned caesarean section, the incision is made transversely in the lower uterine segment. This approach provides a high probability of the usefulness of the future scar (it is possible to match the edges well, they grow together correctly, and the seam will be able to endure pregnancy and even natural childbirth). In emergency situations, when the doctor needs to provide quick access to the fetus, a longitudinal incision is made, it often gives a failed suture.

The thickness of the scar on the organ from 5 mm is considered normal - with this indicator, pregnancy and spontaneous childbirth are allowed after full recovery. When the uterus is stretched by the fetus, the ideal option is when the suture becomes thinner to 3 mm, but even with 1 mm in the last trimester, doctors give a positive prognosis.

Seam failure

The scar after the operation requires observation, as its failure is possible. Signs of this condition are:

• healed inner suture is thinner than 3 mm;
• in the area of ​​the scar there are multiple dense inclusions;
• local pain when examined by a doctor;
• on the x-ray of the uterine cavity with contrast, the heterogeneity of the scar is visible, the change in contours;
• during hysteroscopy (the introduction of an optical device into the cavity of the organ to examine its walls), a large number of white inclusions are found on the seam.

Complications in postpartum recovery

The postpartum period does not always proceed smoothly; in some cases, pathological conditions of varying degrees of complexity are formed that require mandatory medical care.

Hypotension and atony during the restoration of the uterus

After a successful delivery, the uterus should begin its active contraction, but this process may fail. The state of hypotension is described as a decrease in the contractility of the abdominal organ, which can be corrected by mechanical and medical methods. Atony is an extreme condition, paralysis of the uterus, when its tone cannot be stimulated by any stimuli.

An increased risk of pathology is caused by the following factors:

• too young age of the woman in labor, unpreparedness of the body for pregnancy;
• myoma;
• large fruit;
• weak generic activity;
• numerous births, during which the muscles of the organ have weakened and are unable to actively contract;
• pathological location of the placenta;
• the presence of a scar after a previous surgical delivery.

The main symptom of the pathological condition is severe bleeding, since in the absence of contractions, large vessels in the organ do not close. For this reason, treatment primarily comes down to stopping blood loss: an external massage of the organ is performed, ice is applied to the lower abdomen, and contractile activity is stimulated by the administration of drugs (Oxytocin, Dinoprost). If the blood loss is prolonged and profuse, then surgical intervention is required.

Eversion of the uterus

An eversion is a displacement of an organ, in which it partially or completely falls out, turning inside out with a mucous membrane. In the postpartum period, pathology can be caused spontaneously due to weakness of the muscle elements, or as a result of the rough actions of medical personnel (pulling the placenta that has not yet separated by the umbilical cord, excessive pressure on the abdomen).

The problem is eliminated by manual reduction of the organ into place, and is supplemented by conservative therapy (taking cholinomimetics to spasm the cervix, introducing an aqueous solution to increase pressure, and washing the organ cavity with antiseptic agents). If manual reduction is not possible, surgical intervention is resorted to. If more than a day has passed after the eversion and no measures have been taken, then the organ has to be removed.

When eversion of the uterus, the doctor resorts to the technique of manual reduction of the organ

Retroflexion of the uterus

Retroflection is a pathological change in the uterus associated with its abnormal location in the small pelvis. With an active contraction of the stretched organ after childbirth, it may not be positioned correctly, forming a bend in the body of the uterus.

The bend of the body of the uterus can form in the postpartum period with an active contraction of the stretched organ

There are few causes of pathology:

• weak ligament tone;
• muscle weakness in the pelvis;
• infection brought into the abdominal cavity during a caesarean section.

Therapy of the abnormal location of the organ implies an integrated approach: procedures to increase the tone of the muscles of the perineum, gynecological massage, taking vitamin and homeopathic preparations, special physiotherapy exercises.

Remains of the placenta in the uterus

In the process of labor, there are situations when the placenta does not leave the uterus completely, and its parts remain in the cavity of the organ. If the doctor did not notice a defect in the placental lobules, then in the postpartum period, the puerperal begins to profuse bleeding, an inflammatory process develops with an increase in temperature and a general deterioration in the condition. Usually, the delayed parts are found on a planned ultrasound after childbirth. To eliminate them, a curettage procedure is performed under general anesthesia, after which drugs are prescribed to prevent the infectious process and relieve spasm of the uterine neck.

Fluid in the uterus

Normally, fluid from the uterine cavity after delivery comes out gradually in the form of lochia. In some puerperas, this process is disrupted, and a lochiometer occurs - a difficulty in the outflow of postpartum masses from the organ. Pathology can be formed both after natural childbirth and after surgical delivery. Without timely evacuation, the accumulation of discharge can become the basis of serious complications, in particular, infectious inflammation due to the activity of bacteria in decaying tissues.

The problem can form for several reasons:

• mechanical obstruction (large pieces of the placenta, blood clot, parts of exfoliated mucosa that clogged the "exit");
• hypotension and atony of the uterus.

The only way to deal with the lochiometer is to eliminate the cause of the stagnation. Blockage of the cervical canal with clots and scraps of tissue requires forced expansion of the area, and reduced contractile activity requires drug stimulation. As soon as the limiting factor is removed, the fluid itself is evacuated from the organ cavity. If the problem was not detected immediately, and the infectious process began, you can not do without a course of antibiotics.

Pain in the uterus

With an uncomplicated delivery, pain in the abdomen is considered normal. They are not intense, do not require medical therapy, and are more often described by women as aching discomfort. Pain can intensify during breastfeeding, when the contractile activity of the uterus is activated. Usually relief comes within a few days.

Severe and prolonged pain indicates a problem. This may be an inflammatory process, fluid accumulation, bleeding, etc. If you suspect complications in the postpartum period, you need to urgently consult a doctor.

The body recovers after childbirth gradually, and this process takes time - from 2 to 6 months, depending on the characteristics of delivery. It is important for a newly-made mother to carefully monitor her condition in order to prevent dangerous complications.