Immediately after the baby leaves the uterus during labor, the process of reverse development of the female reproductive organ begins. During pregnancy, the uterus grows almost 500 times. It is clear that it cannot immediately decrease to its original size after childbirth.
We will describe in this article how the process of reverse development proceeds, what can affect it and what violations can be.
How is it going normally?
The process of reverse development of the reproductive organ in women after the birth of a child is called involution in medicine. Involution is a term that does not mean anything pathological, it is a description of a process and nothing more. The uterus fulfilled its task - it helped to bear and give birth to a child. Now her task is to return to the original parameters, restore functions, so that the woman becomes fertile again and can conceive, bear and give birth to the next baby.
In primiparous and multiparous women by time the involution process normally lasts about 6-8 weeks... This is a complex and multi-step process. Immediately after the baby is born, the uterus weighs about a kilogram, its volume is normally in the range of 4900-5250 ml, the length of the uterus (if immediately measured by ultrasound) is about 22-25 centimeters, and in diameter it is almost 15 centimeters ... The uterus is located above the small pelvis and, in fact, is an empty bag from which all the contents were taken.
It should be noted that before pregnancy, the female uterus has a very small volume (no more than 5 ml), and the weight of the reproductive organ is 60-70 grams. To reach this size again, the uterus and the entire female body will have to "try".
What happens inside the reproductive organ? The fibers of the uterine tissue (myometrium) are gradually reduced. Most intensively this process takes place in the first 3-4 days after the birth of the child, but then involution does not stop. When the stretched, overgrown fibers contract, the vessels narrow.
Gradually, their complete closure occurs, and the fibers that have become unnecessary die off and come out in the form of lochia - bloody postpartum discharge with clots. If one part of the decidual layer is rejected during contraction, then the second remains to become the basis for a new endometrial layer.
Involution starts immediately after the uterine cavity leaves the placenta (afterbirth).
In many ways, the process is due to a change in the hormonal background: a low amount of progesterone, high oxytocin in the blood of the postpartum women provide the contractile ability of the reproductive organ.
At the time of involution, myometrial receptors, which are most sensitive to oxytocin, are activated more than others.
From the birthday of the baby, the mother begins a countdown until the end of involution. Every day, the uterus descends 1-1.4 centimeters, gradually she should take the previous position in the small pelvis. Return to the pelvis ends 10-11 days after childbirth.
The cervix closes smoothly, a day after childbirth, it becomes 5 centimeters smaller, but remains ajar, which facilitates the exit of lochia. The internal cervical os closes two weeks after delivery, and the external one only after two months.
After the first birth, the closed external pharynx becomes no longer round, but transverse, and this is the main difference between the cervix of a woman who has given birth and who has not given birth. After the second or third birth, the shape of the pharynx is the same, only the process of involution proceeds a little slower due to the fact that the walls of the uterus and the musculature of the cervix are fairly stretched and less elastic.
After childbirth, there is a placental wound inside the uterus - the placenta attachment site. It is she who bleeds in the first days after childbirth, and it is in this that the main difference between lochia and menstruation is. The wound heals and heals by about 4 weeks postpartum.
After a cesarean section, all processes are identical, but the situation is complicated by the presence of a scar on the body of the uterus.
That is why the involution is somewhat delayed and can take up to 4-5 months.
The sensations that accompany involution are normally reminiscent of menstrual pain, but they are much stronger. Some women compare the sensation to the onset of labor. But they are so only in the first days, already a week after the birth of the child, the process of the reverse development of the uterus will become almost imperceptible for a woman.
What influences?
The contractility of the uterus after childbirth is influenced by numerous factors: the number of births, the nature of the last birth, the woman's age, as well as the possible development of postpartum complications. The hormone oxytocin has a special effect, which is produced exactly in the amount that is necessary for the involution of the reproductive organ during breastfeeding. This irritates the nipple receptors, which send "signals" to the brain, stimulates the production of prolactin and oxytocin. If a woman is not breastfeeding, she should be given oxytocin. in injections.
Early attachment to the breast, breastfeeding can accelerate involution. In order for the uterus to contract faster and return to its previous size, a sufficiently active motor regime is recommended without lifting heavy weights and unbearable physical exertion.
If the woman lies all the time, then the contraction will go slowly.
Subinvolution
As you might guess from the presence of the prefix, the term means that involution proceeds pathologically, or, more precisely, not completely or partially. Among all postpartum complications, this situation occurs quite often: about 2% of puerperas are faced with the fact that the uterus contracts poorly, for a long time, the contractions are painful, the reproductive organ cannot achieve the required size.
Among other types of complications of the postpartum period, subinvolution holds a record place - up to 50% of all complications are of this nature.
Since in most cases, poor contractility occurs against the background of an inflammatory disease - endometritis, scientists have not yet decided whether to consider subinvolution as a separate pathology or to consider it only as a symptomatic sign of endometritis. The development of this condition is almost always associated with a violation of the contractility of the uterine tissue (myometrium).
But it can develop due to many individual factors and in their totality. It is believed to be affected by tissue edema after childbirth, as well as the slower formation of collagen fibers.
After a multiple pregnancy or pregnancy with a large baby, as well as if there have already been more than two births in the anamnesis, there is a risk of violation of the contractility of muscle tissue due to its overstretching.
If an infection has penetrated into the uterus at any stage of labor or before them, then the likelihood of subinvolution of the uterus increases sharply, since the presence of infectious inflammation slows down the process of reducing the natural early postpartum tissue edema.
Causes
In most cases, when asked why the uterus contracts poorly, obstetricians answer that it is an infection. This refers to the inflammatory process that was provoked by viruses or pathogenic bacteria that entered the uterine cavity. Despite this, infection does not always cause weak contractility, sometimes endometriosis is diagnosed after childbirth as a separate disease, while the processes of involution in the postpartum woman are not disturbed. Therefore, it was decided to display not a list of reasons for subinvolution, but a list of predisposing factors and circumstances that increase the likelihood of an incorrect reverse development of the reproductive female organ after the birth process.
Such situations include the following factors.
- Incomplete discharge of the placenta... Particles of the placenta and fragments of membranes remained in the uterus. After the birth of the placenta, obstetricians are obliged to make sure that the uterine cavity is cleaned, but this is done manually, that is, almost by touch. Revision of the placenta is carried out on the obstetric table, checking the presence of all lobules and membranes in the "child's place".
If there were ruptures of the placenta, then it, like puzzles, is collected in parts. This method avoids leaving large fragments, but leaving small ones is not safe.
- Complications in the process of bearing a fetus... This category of risk factors for subinvolution includes a large fetus (more than 4 kilograms at birth), polyhydramnios, multiple pregnancies, that is, factors that contribute to excessive stretching of the walls of the reproductive organ.
An exacerbation of cystitis and pyelonephritis during pregnancy, especially at the very end, is also considered an unfavorable factor, since these ailments increase the likelihood of infection entering the uterine cavity immediately after the birth of the baby.
- Complicated labor... Subinvolution is most often found in women who gave birth rapidly, as well as in those whose labor was delayed.
- Physique features... It is believed that stunted women are more likely to experience impaired uterine contraction in the postpartum period than tall or medium-sized women.
- Genetic features... If a woman's mother or grandmother suffered from subinvolution after childbirth, then the likelihood that the same will happen to their female descendants is very high.
To others adverse factors include the presence of uterine fibroids, the age of the postpartum woman under 19 and after 35 years, the inability to breastfeed in the first days after childbirth, as well as various individual features of the structure of the uterus, for example, incorrect location of the genital organ, disruption of its ligamentous apparatus.
Sometimes the uterus contracts poorly in puerperas with severe anemia, as well as those with chronic diseases of the heart and blood vessels.
Kinds
In obstetrics, several types of violations of uterine contraction in the postpartum period are distinguished. Some exist mainly on the pages of obstetric textbooks and in real life are found in isolated cases.
- True subinvolution - a rare pathology in which the uterus contracts poorly or does not contract at all for no apparent reason (there is no inflammation, no infection, no parts of the placenta in it). In this group, there is a myogenic disorder, in which the absence of involution is associated with a violation of muscle elasticity, a myocirculatory disorder, in which tissue edema slowly decreases and the circulatory network of the reproductive organ is restored worse, as well as an endocrine disorder, in which the production of natural oxytocin in the female body is insufficient.
- Infectious subinvolution - a very common phenomenon in which the contractile ability of the reproductive organ is impaired due to a bacterial or viral inflammatory process in the uterine cavity.
Symptoms and signs
The allocation of lochia after childbirth is a normal phenomenon, but normally on the fifth day they become smaller, the nature of the discharge changes to mucous. Subinvolution is indicated by the persistence of bright and rather abundant lochia of a brownish color for several weeks.
Also, indirectly, a violation of uterine contraction may be indicated by the absence of painful cramps in the lower abdomen while feeding the baby with breast milk.
Some women notice unpleasant pulling pains almost constantly, while they do not depend in any way on the breastfeeding regimen.
If the violation is of an infectious nature (which is most likely, given the prevalence of just such subinvolution), then the symptoms will fully correspond to the symptoms and signs of endometritis. A high temperature rises, a feeling of chills appears. If at the same time the lochia ceases to be bloody and becomes greenish or yellow with an unpleasant odor, they speak of purulent endometritis.
Touching the abdomen, the doctor's attempts to palpate it through the anterior abdominal wall cause pain in the postpartum woman, as inflammation develops, headaches, weakness intensify, nausea and heart rhythm disturbances may appear.
Diagnostics
Violation of uterine contraction at the current level of development of diagnostic medicine is usually not only easily determined, but also predicted. Even during pregnancy, among all expectant mothers, obstetricians-gynecologists single out women who have increased risks of such consequences. These are future mothers of very short stature, and multiparous, and those who carry twins or triplets, as well as those carrying large babies, suffering from polyhydramnios and gestosis in late pregnancy. They are closely monitored not only during the gestation period, but also in the very early postpartum period.
After the birth of a baby, a consultation with an obstetrician can be used to establish a woman's reproductive organ contraction disorders. The doctor identifies the duration, nature and volume of postpartum discharge, evaluates other symptoms characteristic of subinvolution.
To clarify and confirm the diagnosis, a gynecological examination is performed. On the chair, the size of the uterus, its irregular shape, is unacceptable in terms of the postpartum period. The cervical canal of the cervix is slightly open, there may be an accumulation of blood clots in it, the cervix has a purple or purple color, it is edematous. Ultrasound shows the exact size of the uterus, as well as the thickening of its walls... If there is something foreign in the cavity of the reproductive organ, then this is also confirmed by ultrasound examination with great accuracy.
Also, hysteroscopy can come to the aid of doctors. This study provides accurate answers to all questions, in addition, it is possible to take a tissue sample from the inner surface of the reproductive organ for analysis, which allows you to accurately determine the type of infectious agent. A woman is analyzed urine and blood, a smear from the vagina is taken for the microflora.
In severe cases, an MRI of the pelvic organs may be prescribed.
Treatment
Violation of uterine contraction after the birth of a baby necessarily requires treatment. Whatever the cause of the violation initially, sooner or later, if untreated, it becomes infectious, a full-fledged endometritis or endomyometritis develops. If such conditions are not treated, then the development of sepsis, peritonitis, septic shock, severe uterine bleeding is possible.... Previously, these complications were a fairly common cause of death after childbirth. Now there is every opportunity not to bring the problem to mortal danger and serious consequences, for this you need to start treatment on time.
You can help a woman comprehensively. Treatment consists of the use of drugs, instrumental therapy and massage... If a bacterial infection is detected, first of all, they begin to fight it: the woman is shown antibiotics in tablets, in injections - how exactly, the doctor decides based on the severity of the inflammatory process.
How long the treatment will last is difficult to say, in each case the general state of the mother's immunity and the peculiarities of her pathology play a role.
For treatment, hormonal preparations based on oxytocin are used - "Oxytocin", "Methylergometrine", etc. They improve the contractility of the uterine tissues... If fragments of the placenta or fetal membranes are found in the uterine cavity, if blood clots accumulate in it, clogging the cervical canal, all foreign matter is removed from the cavity of the reproductive organ. This occurs under anesthesia by vacuum aspiration or by curettage (curettage) using obstetric instruments. This ultimately allows the uterus to contract completely.
Pain relievers are used to relieve pain. to relax the cervix in case of accumulation of clots, use "No-shpa" and other antispasmodics in combination with hormonal drugs to enhance the contractility of the myometrium.
Treatment most often takes place in a hospital, where it is possible to constantly monitor the dynamics, do tests and, if necessary, supplement or replace drugs in the therapy regimen, administer drugs in the form of a dropper. Gynecological massage has proven itself well in the treatment of subinvolution of the uterus, which improves the condition of the myometrium and accelerates recovery after childbirth.
Shown bed rest. A woman should not strain too much, experience physical exertion, stress.
After the acute period of inflammation is over, physiotherapy sessions and therapeutic exercises are recommended.
The predictions of doctors upon detection of subinvolution of the uterus after the birth process are usually positive and favorable, since pathology responds well to treatment... And this is the reason to stop worrying and worrying about the fact that the doctor believes that the uterus is contracting worse than necessary. The situation is unpleasant, but not critical.
To prevent problems with uterine contraction women at risk are recommended to administer oxytocin in the first hours and days after childbirth in injections, regardless of whether they have symptoms of mild involution or not.
Folk remedies
It should be understood that in this case it is impossible to replace traditional treatment with folk remedies.
In addition, you should not prescribe folk remedies yourself, because they can affect the quality of breast milk and the well-being of the child.
At home alternative medicine prescriptions can help improve uterine recovery after the acute period of inflammation is over... There are pharmaceutical herbal preparations based on arnica flowers, nettle leaves and roots, from which you can prepare an aqueous tincture for ingestion.
Other herbs that help cleanse the uterine cavity include yarrow, shepherd's purse, and horsetail. In addition to drinking, these herbal remedies are used for cleaning baths.
Reviews of women
According to women, after the introduction of oxytocin, pain in the lower abdomen becomes more pronounced, some describe them as quite strong and unpleasant. In the majority of women in labor, problems with the contractile ability of the uterus can be detected even in the maternity hospital, for this, a control ultrasound is done for 2-3 days and only after it a decision is made about whether it is possible to write the mother and baby home.
In some cases, symptoms appear already after being discharged home, which is why new mothers are advised to closely monitor the nature of the discharge and body temperature during the first 10-12 days after discharge.
If warning signs are found, you should immediately consult a doctor, and if bleeding is discovered and a high temperature rises, call an ambulance.
According to women, after treatment, there were no problems and consequences... Some took several weeks to insert vaginal suppositories with anti-inflammatory sanitizing effect. The pathology did not affect the subsequent pregnancy., although there is a certain percentage of reviews indicating that women, after undergoing subinvolution, had problems with conception when planning a subsequent pregnancy.
