Description

Subinvolution is delayed return of the enlarged uterus to normal size and function.

Etiology
Subinvolution results from retained placental fragments and membranes, endometritis, or uterine
fibroid tumor; treatment depends on the cause .

Pathophysiology
Uterine atony or placental fragments prevent the uterus from contracting effectively.

Assessment Findings/Clinical manifestations

Prolonged lochial discharge
Irregular or excessive bleeding
Larger than normal uterus
Boggy uterus (occasionally)

Complications
✓ orthostatic hypotension, which is lightheadedness or dizziness due to low blood pressure.
✓ anemia.
✓ fatigue.
✓ an increased risk of postpartum hemorrhage in a later pregnancy.

Medical Treatment

1. Administration of oxytocic medication to improve uterine muscle tone. Oxytocic medication includes
(a) Methergine®-a drug of choice since it can be given by mouth.
(b) Pitocin®.
(c) Ergotrate®.
2. Dilation and curettage (D&C) to remove any placental fragments.
3. Antimicrobial therapy for endometritis.

Analysis/nursing diagnosis
1. Pain related to tender, inflamed uterus secondary to endometritis.
2. Anxiety/fear related to change in physical status.
3. Knowledge deficit related to diagnosis, treatment, prognosis.
4. High risk for injury related to infection.
5. Fluid volume deficit related to excessive bleeding.

Pharmacologic therapy/ treatment

1. Heparin sodium injection (Hepalean) Lovenox
2. Warfarin sodium (Coumadin, Warfilone)
3. Oxytoxic methylergonovine maleate (methergine)

Nursing Management
1. Prevent excessive blood loss, infection, and other complications.
 ✓Massage uterus, facilitate voiding, and report blood loss.
✓Monitor blood pressure and pulse rate.
✓Administer prescribed medications. (see Drug Chart )
✓Be prepared for possible D&C.
2. Assist the client and family to deal with physical and emotional stresses of postpartum complications.

✓BepreparedforpossibleD&C.
2.Assisttheclientandfamilytodealwithphysicalandemotionalstressesofpostpartum complications