Subinvolutio uteri puerperalis
What is subinvolutio uteri puerperalis?
With the birth of a child, the female body undergoes a major effort that manifests anatomically in various changes. During the period of the weekbed, the body of the newly minted mother recovers from the birth effort and returns to its original state.
This is true both on an emotional and on a biological level. The hormone balance is restored and changes regress. In this period, back disorders can occur. One of these is Subinvolutio uteri puerperalis. The uterus of those affected forms only insufficiently. At the same time, an increasingly bloody weekly flow begins.
The postpartum period lasts for a period of up to eight weeks after the birth of the child. If the uterus does not recover sufficiently during this period, the diagnosis is close to sub-aphid puterus. The newly minted mother can support the regression of her body through various activities. Absence of such own efforts for the regression, back disorders are favored.
Different causes of regression disorders are particularly common. For example, women with overextended uterine hypertension are particularly susceptible to disorders such as subinvolutia uteri puerperalis. The same is true for women with limp connective tissue, including for those with multiple births.
Other causes of subinvolutia uteri puerperalis may be remnants of the placenta, which are left in the uterine cavity and complicate the regression. In addition, the phenomenon may be favored by uterine fibroids or congenital uterine malformations acquired as a result of previous pregnancies or surgery.
In addition, endometritis and hormonal absenteeism during weaning are a common cause of the disorder. In addition, cases are documented in which the lack of exercise of the newly minted mother has caused subpiritual uteri puerperalis.
Symptoms, complaints & signs
Patients with Subinvolutio uteri puerperalis notice the regression disorder, especially in a bloody weekly discharge. In addition, the lack of regression in individual cases can be palpated in the area of the postpartum uterus.
The fundus uteri stands out more or less high or at least does not develop back in the childbed days. In addition, the uterus feels unusually soft. Not every woman notices the regression disorder during a palpation. The bloody and increased weekly flow is therefore understood as a key symptom for self-diagnosis.
Patients with the disorder may suffer from other symptoms that only develop from the subinvolutia uteri puerperalis phenomenon. Ascendant infections are particularly prevalent as a consequence, for example. The key symptom for these infections is puerperal fever, which simulates an inflammatory change in the genital tract and is caused by invading bacteria in the birth wound.
Diagnosis & disease course
To make a diagnosis of subinvolutio uteri puerperalis, the doctor performs a clinical examination including palpation of the uterus. An essential criterion for the diagnosis is a highly palpable uterus, which is clearly too sublime in view of the respective day of childbirth. To ensure the diagnosis, ultrasound examinations of the uterus are used.
Differential diagnosis should explain the causes of the disorder. In the ultrasound examination, causes such as remaining remnants of the placenta, for example, can easily be recognized. The prognosis for patients with subinvolutia uteri puerperalis depends mainly on the primary cause of the condition. For example, women with particularly weak connective tissue will also be susceptible to the disease in subsequent pregnancies.
In this disease, the sufferers primarily suffer from an excessively bloody weekly discharge. This discharge also occurs over a longer period of time and in many cases is also associated with pain. Significant regression can also be felt in the area of the uterus, which can easily lead to panic among many affected persons.
Furthermore, it can come to illness due to infections. Most sufferers also suffer from a high fever and at the same time a tiredness and a fatigue. The quality of life of those affected is significantly reduced and limited by the disease. If the infections are not treated, it can come in the worst case to a blood poisoning and thus the death of the patient.
However, this can be avoided relatively easily. The treatment of this disease takes place without complications. With the help of various therapies and sufficient exercise, the symptoms can be reduced.
This usually leads to a positive disease course. In some cases, those affected depend on taking medication. In general, the life expectancy of the patient is not adversely affected by the subinvolutio uteri puerperalis.
When should you go to the doctor?
In the case of subinvolutio uteri puerperalis, the patient is always dependent on medical treatment to prevent further complications or discomfort. Since it can not come to an independent healing, a visit to a doctor is inevitable. The sooner the doctor is contacted, the better is usually the further course.
As a rule, a subcutaneous uterine puerperal nerve should be contacted by a doctor if the person has a bloody discharge. This discharge can leak out at various points of the body and significantly limit the quality of life of the person affected. In addition, high fever may indicate the subinvolutio uteri puerperalis. Should it therefore come after a serious procedure to a high fever, then a doctor should also be contacted. In most cases, sufferers also suffer from various infections or inflammation.
In the case of subinvolutio uteri puerperalis, first and foremost a general practitioner can be contacted, whereby the treatment is usually carried out with the aid of medication. Whether the disease reduces the life expectancy of the person affected can not be universally predicted.
Treatment & Therapy
Patients with disability in the puerperium are asked by the doctor to support their own body in the regression. This support can mean, for example, targeted and regular exercise. The regression of the uterus can often be naturally triggered by such increased activity of movement.
If physical inactivity has been the cause of the disorder, the movement units are causal therapies that address the cause of the problem. In addition to the self-efforts, a conservative drug therapy of the disorder can occur.
Contraceptives such as ergotamine or oxytocin accelerate the uterine involution and can be used as supportive treatment steps. If remnants of the placenta that were left behind during the ultrasound examination were found to be the cause of the disorder, movement units and supportive drug administration are usually insufficient for recovery.
In most cases, the doctor advises an invasive procedure in this situation. The curettage of the uterine cavity may be indicated in this case. If uterine fibroids prevent uterine regression, then an invasive or at least minimally invasive procedure to eradicate the fibroids is also indicated in this context.
In the context of regression disorders such as subinvolutio uteri puerperalis, prevention is almost more important than aftercare. For example, women can take measures to strengthen their connective tissue well before pregnancy. In addition, movement in the phase of the weekly bed is one of the most important preventive measures.
It is not always possible to avoid the disorder due to these steps. Despite multiple efforts, the phenomenon of subinvolutia uteri puerperalis can occur, especially after multiple pregnancies. However, by means of the prevention measures, the risk is at least lowered.
The follow-up of the subinvolutio uteri puerperalis follows directly on the womb recovery therapy. The patients should also continue to train in their everyday life and thus promote the natural regression. Often the disease or regression disorder follows a lack of exercise. If this is the case, targeted exercise therapy may be enough for recovery.
In other cases, the self-effort is merely a support. If necessary, the gynecologist also recommends a drug treatment, to which, however, the physiotherapeutic follow-up can follow. This type of aftercare is also suitable as a precautionary measure. Because even before her pregnancy, women can train and strengthen their connective tissue.
Here prevention and aftercare go directly into each other. Especially after a multiple pregnancy, the risk of regression disorder is very large. If it comes in addition to a bloody discharge, the patients must pay attention to a particularly careful body hygiene. Then they also need a certain amount of time.
Only when the increased discharge ceases, they should start with the physiotherapeutic aftercare and treat their body with care. Close observation of the physical changes helps to identify any problems. The doctor or midwife will help the patients with questions and give tips for effective recovery therapy.
You can do that yourself
Many of the affected women are symptom free. They are not limited by the subinvolutio uteri puerperalis in their everyday life and therefore need not take any special measures.
In contrast, patients with severe, bloody discharge require particularly strict personal hygiene. The weekly flow should ideally be collected with large, unperfumed and breathable bandages. To avoid infections, they must be changed regularly. Under no circumstances should women with subinvolutio uteri puerperalis use tampons or menstrual cups. They can interfere with the outflow of the weekly flow secret and aggravate the regression disorder. Sex is also discouraged.
In the subinvolutio uteri puerperalis it is generally helpful for affected women to take the prone position. Supportive acts when a small pillow roll is pushed at the umbilical level. However, if pain occurs, this measure is not recommended. Even abdominal massages or abdominal compressions with essential oils as well as the placing of ice bags on the abdomen of the affected persons can bring relief. However, it is always advisable to consult a midwife.
In particular, after a caesarean section, these measures should generally not take place without consultation with a doctor. The regression can be supported a few weeks after delivery by exercise and physical activity such as targeted recovery gymnastics.