UTERINE SUBINVOLUSION~~Dr. St.

Nur Asni
Dr.Ezyan
INTRODUCTION
SUBINVOLUTION OF THE UTERUS

The major cause of secondary

postpartumhemorrhage

PATHOPHYSIOLOGY
SUBINVOLUTION OF THE
UTERUS delayed involution of
the uterus

by:

results in failure of
obliteration of blood vessels
at the placental site
leading to prolonged bleeding

3
5

4
6

1)at delivery
2)8 hour
postpartum
3)8 days postpartum 4)14days
postpartum
5)17days postpartum 6)24days
postpartum
7) 120days postpartum
ETIOLOGY

RISK FACTORS
Endometritis usually follows
1) Prolonged rupture of
membranes
2) Prolonged labor
3) Emergency Cesarean section

MANAGEMENT

DIFFERENTIATION BETWEEN THE

Two
CAUSES IS OFTEN DIFFICULT

infection and
inflammation
(endometritis)

retained placental
tissue.

BOTH CONDITIONS MAY

CO-EXIST.

SIGNS AND SYMPTOMS

RETAINED PLACENTAL TISSUE
more common in
Offensive
lochia

Maternal
pyrexia

Uterine
tenderne
ss

a previous history of retained

placenta
OR
if there were concerns of
incomplete
placenta and/or membranes.

RESUSCITATION

 Initial management should

include RESUSCITATION
Use UTEROTONIC AGENTS
Administer ANTIBIOTICS
Consider SURGICAL
EVACUATION OF THE UTERUS
AIRWAY

VAGINAL DELIVERY mild

ENDOMETRITIS: Single broad
spectrum antibiotic (eg.
Ampicillin 1 g IV q6h OR orally)
if CESAREAN SECTION:
Flagyl 500 mg q8h + Cefoxitin
2g q6h
OR
Aminoglycoside (Gentamycin) 60-

MANAGEMENT - ABCS
talk to and observe patient
large bore IV access ( 16 gauge)
crystalloid - lots!
CBC
cross-match and type
get HELP!
UTEROTONIC AGENTS
Management - Oxytocin
Management - Uterotonics
5 units IV bolus
Ergotamine - caution in
hypertension
20 units per L N/S IV
0.25 mg IM or 0.125 mg IV
wide open
10 units
maximum dose 1.25 mg
intramyometrial given
Cytotec (misoprostol) - caution
transabdominally
in asthma
400 mg pr or po

A
B
C

= airway
= breathing
= circulation

ANTIBIOTICS
if IV antibiotics used, continue
for 48 hours after fever has
stopped.
if fever continues and
aminoglycoside-clindamycin
combination was used, add
penicillin (5M units q6h) to
cover enterococci
PO antibiotics should be used

The more antibiotics used, the

higher the chance of
necrotizing colitis
Antibiotics do appear in breast
milk but in most cases are not
significant (avoid
tetracyclines)

100 mg
q8h + Clindamycin 900 mg q8h

for 5 days