SUBINVOLUTION OF

UTERUS
 INTRODUCTION
After nine months of housing a growing

baby, the uterus has to shrink back down

to its pre-pregnancy shape and size, the
uterus continues to contract after this. If
the process happens too slowly, the
uterus remains enlarged. This condition is
called subinvolution.
 DEFINITION
The medical condition when the involution of

uterus is impaired or retarded, it is known as

subinvolution of uterus.
(Acc. to D.C. Dutta)
 

Delayed or absent involution of the uterus

during the postpartum period is known as

subinvolution of uterus.
(Acc. to Medical Dictionary)
ETIOLOGICAL FACTORS
*Predisposing factors
grand multiparity
overdistension of uterus as in twins and hydramnios
ill maternal health
uterine prolapse
retroversion after the uterus becomes pelvic organ
uterine fibroid

*Aggravating factors
Retained products of conception
Uterine sepsis, endometritis
CLINICAL MANIFESTATIONS
*Symptoms

The condition may be asymptomatic. The

predominant symptoms are:
Abnormal lochial discharge either excessive

or prolonged.
Irregular or at times excessive uterine

bleeding.
Irregular cramp like pain is cases of retained

products or rise of temperature in sepsis.

CONT..
Signs
The uterine height is greater than the normal for

the particular day of puerperium. Normal

puerperal uterus may be displaced by a full
bladder or a loaded rectum. It feels boggy and
softer upon palpation.
MANAGEMENT
Antibiotics in endometritis.

Exploration of the uterus in retained products.

Pessary in prolapsed and retroversion.

Ergometrine so often prescribed to enhance the

involution process by reducing the blood flow

of the uterus.
VAGINAL PESSARY
PUEPERIAL
SHOCK
DEFINITION
Shock is defined as a state of

circulatory inadequacy with poor

tissue perfusion resulting in
generalized cellular hypoxia leading
to dysfunction of organs and cells.
TYPES OF PUEPERIAL SHOCK
CLASSIFICATION OF SHOCK BASED ON THE BASIC
PATHOPHYSIOLOGY:
1. HYPOVOLEMIC SHOCK:
 Hemorrhagic shock
 Fluid loss shock
 Supine hypotensive shock syndrome
 Shock associated with disseminated intravascular
coagulation.
2. SEPTIC SHOCK
3. CARDIOGENIC SHOCK
4. NEUROGENIC SHOCK.
5. ANAPHYLACTIC SHOCK
HYPOVOLEMIC SHOCK
STAGES OF HYPOVOLEMIC SHOCK
INITIAL STAGE
COMPENSATORY STAGE
PROGRESSIVE STAGE
LATE STAGE
MANAGEMENT
 Maintain airway
 Replace fluids
 Avoid warmth
 Control of hemorrhage
 Clinical observation of the mother in shock
TREATMENT
RESUSCITATION FOLLOWS:- ABC
A. AIRWAY: Patent airway is assured and high
pressure oxygen (15l/min)using mask
/endotracheal intubation.
B. BREATHING: Ventilation checked and
supported if needed.
C. CIRCULATION:
 Restore blood volume and reverse hypotension
with colloids.
 Initial request for 4-6 units of blood should be
sent. Blood may be transfused.
SEPTIC SHOCK
CLINICAL SIGNS

Flushing of face and skin feels warm.

Temperature rise varies from 1010F to 1050F

Hemorrhage may be present.

Anuria , cardiac or respiratory distress and

coma may occur.

Disseminated intravascular coagulation

Multisystem organ failure.

MANAGEMENT
Antibiotics
Intravenous fluids and
electrolytes
Corticosteroids are given
Maintenance of blood pressure
CARDIOGENIC SHOCK
The failure of heart to provide adequate
output causes cardiogenic shock.
TREATMENT
Early diagnosis of cardiac lesions & surgical
correction.
Avoid pregnancy if cardiac condition is not
under control.
ANAPHYLACTIC SHOCK
Serious allergic reaction that is rapid in onset
causes anaphylactic shock.
CAUSES
Pharmacological agents
Insect sting / bite
Foods
Latex
MANAGEMENT
Stop administration of suspected materials/
drugs.
Inj. Diluted adrenalin ,IV 1ml is administered
andstart vasopressor drugs(dopamine,
dobutamine..etc)
Monitor B.P
THANK YOU