B.

Sc DEGREE COURSE IN NURSING (BASIC)

Midwifery and Obstetrical Nursing

Unit: IX.
Subinvolution

Dr. P. PADMAVTHI, PRINCIAPL

Objectives;
 At the end of the class the student will be able to

 Explain the definition of sub involution

 List down the causes

 Explain the signs and symptoms

 Describe the management of sub involution

 Definition

• Subinvolution is a medical condition

in which after childbirth, the uterus

does not return to its normal size.

• When the involution is impaired is

called sub-involution.
Causes of sub involution .

Predisposing factors:
• Grand multiparity.
• Overdistension of uterus as in twins and hydramnios.
• Maternal ill health
• Caesarean section.
• Uterine prolapse.
• Retroversion after the uterus becomes pelvic organ.
• Uterine fibroids
Cont..
• AGGREAVATING FACTORS:

 Uterine sepsis (Endometritis)

 Retained products of conception

 Signs and Symptoms

May be asymptomatic sometimes

 Abnormal Lochial Discharge : Excessive or prolonged

 Irregular at times Excessive Uterine Bleeding

 Irregular Cramp like Pain (Retained bits)

 Rise of Temperature in case of Sepsis

 Cont..

• Signs

Fundal height Displaced

Fundal height Uterus feels
Bladder or
Greater than Boggy and
Loaded
Postnatal Day Softer
Rectum
 MANAGEMENT

• Exploration of uterus for retained products

• Pessary in prolapse or retroversion

• Methergine to enhance involution process

• Antibiotics in case of infection

• Early ambulation postpartum.

• Daily evaluation of fundal height to document involution. ss

 Cont..

 Medical Treatment.

1) Administration of oxytocic medication to improve uterine muscle tone.

2) Oxytocic medication includes

(a) Methergine - drug of choice since it can be given by mouth.

(b) Pitocin.

(c) Ergotrate.
.
 Cont..

1. Dilation and curettage (D&C) to remove any placental fragments.

2. Antimicrobial therapy for endometritis.

D. Nursing Interventions.

(1) Early ambulation postpartum.

(2) Daily evaluation of fundal height to document involutio

 Bibliography
o Text book of midwifery, Helen varney( CNM) MSN,Jan .M. kribes, 4 th
edition, All india publication, Pg num 1098
o A comprehensive text book of Midwifery, Annama jacob ,M.Sc (N),
9th edition, jaypee brothers publications Pg no; 449
o Text book of obstetrics, DC Dutta MMBS,DGO, 9th edition, Jaypee
brothers publication ,Pg no; 410
o Midwifery for nurses, Marie elizabeth, 2nd edition, CBS publication
,Pg no;385