uterine involution
Introduction
Incomplete introduction of uterus Incomplete uterus is a common complication after childbirth. Under normal circumstances, after delivery, due to the contraction and contraction of uterine muscle fibers, the vascular lumen in the muscular layer is narrowed or even embolized, resulting in a significant reduction in local blood supply, uterine muscle cells. Ischemia occurs autolysis and gradually shrinks, cytoplasm is reduced, so the uterus volume is significantly reduced. The placental dissection surface in the uterine cavity shrinks with the uterus gradually shrinking, and the regeneration of the endometrium allows the exfoliation surface to be repaired. It returns to near non-pregnancy at 5 to 6 weeks postpartum. This process is called uterine involution (involution of uterus). When the above-mentioned function of the old and the old is hindered, the subinvolution of uterus occurs. basic knowledge The proportion of sickness: 0.01% Susceptible people: women Mode of infection: non-infectious Complications: endometritis pelvic inflammatory disease
Cause
Uterine incompleteness
(1) Causes of the disease
The main reasons that affect the uterine involution and lead to uterine incompleteness are:
Placental factors (27%):
Placenta, residual fetal membrane, incomplete decidual detachment. Excessive placenta area (such as multiple pregnancy, placenta previa, etc.) affects uterine involution, because the muscle layer of the placenta attachment site is thinner, uterine contractility is significantly reduced.
Uterine factors (25%):
Endometritis, uterine myositis or pelvic infection. Uterine fibroids, such as uterine myometrial fibroids, adenomyoma (adenomyoma). Excessive flexion or lateral flexion of the uterus, poor discharge of the lochia, causing the lochia to stay in the uterine cavity. Prolific women have multiple uterine fibrous tissues due to multiple births, affecting uterine contractility.
Over-expansion of the bladder (15%):
Over-expansion of the bladder or bladder is often inflated, the most common form of postpartum urinary retention, common causes of residual placental membranes, endometritis caused by postpartum infection, uterine myositis or pelvic infection, due to excessive uterine flexion or lateral Quail caused by lochia, uterine wall fibroids, uterine adenomyosis, excessive uterine uterus during pregnancy such as multiple pregnancy, excessive amniotic fluid, huge fetus.
(two) pathogenesis
After childbirth, due to the contraction and contraction of the uterus muscle, the vascular lumen is blocked or narrowed in the muscular layer, the uterine muscle cells are ischemic or autolyzed, the uterus volume is significantly reduced, and the placental dissection surface is also reduced and regenerated with the uterus. The endometrium is repaired and repaired. Generally, it can be restored to the non-pregnant state 5 to 6 weeks after birth. This process is called the uterus rejuvenation. When the above function is blocked, the uterus is incomplete.
Prevention
Uterine incomplete prevention
1. During pregnancy, all measures that enhance the physical fitness of pregnant women should be emphasized.
2. After delivery, the placenta and fetal membrane must be properly treated. Care should be taken to check whether the placental membrane is intact, and check whether there is a broken blood vessel at the edge of the fetal placenta, so that the secondary placenta can be found in time. Placenta, part of placenta remains or most of the residual membrane, should be extended into the uterine cavity under strict aseptic operation to remove all residual tissue. If the fetal membrane is checked, only a few residual membranes are confirmed, and the uterine contraction agent can be applied in time. And antibiotics, waiting for their natural discharge and prevention of infection.
3. In order to avoid postpartum urinary retention, the expectant mother will urinate in time within 4 hours after delivery of the placenta. If it is still unable to urinate on its own and is diagnosed as urinary retention 6 hours after delivery, it should be treated promptly and catheterized if necessary.
4.
5. It is necessary to strengthen the care during childbirth and puerperium, as far as possible to prevent the occurrence of uterine insufficiency. If there is any residue, the uterine cavity should be cleaned immediately. At the same time, the uterine contraction agent should be used to promote uterine contraction, preventive application of antibiotics, and active treatment of postpartum urinary retention. Once there is difficulty in postpartum urination, it should be treated as soon as possible, such as hot compressing the lower abdomen, acupuncture, moxibustion, acupoint sealing neostigmine, such as urination still urinary, bladder expansion to near umbilical flat need to be placed continuous catheterization, should avoid long after delivery Time supine position, should get out of bed as soon as possible, bleeding or long-term bleeding, should be B-ultrasound, if there is residue in the uterine cavity, should be performed, the scrape is sent to pathological examination, if there is fever, Patients with increased white blood cells may have infections. They should start high-dose broad-spectrum antibiotic treatment while doing uterine cavity culture. If they are not treated conservatively, surgery may be considered. According to the condition of fibroids, muscles may be feasible. Tumors are excavated and rarely require a hysterectomy.
Complication
Uterine incomplete complications Complications endometritis pelvic inflammatory disease
The main complications are infections including endometrial, pelvic and systemic infections.
Symptom
Uterine insufficiency symptoms Common symptoms Purulent discharge after artificial abortion bleeding sensation severe pain lochia single or double uterus uterus tenderness bloody lochia postpartum lower abdominal pain or...
The most prominent clinical manifestation of uterine incompleteness is the prolongation of bloody lochia, which lasts for only 3 days from normal to 7 to 10 days, or even longer. If the disease is due to placenta residue, bloody lochia lasts for a long time, and the blood volume It is also markedly increased. At this time, the lochia is often turbid or accompanied by odor. Sometimes the residual placental tissue and/or the membrane structure of necrosis can be discharged along with the lochia. If the bloody lochia stops, if there is purulent secretion, it will flow out. It is accompanied by endometrial inflammation. Patients often have low back pain and lower abdominal bulge during this period. However, there are also a small number of patients with very little bloody lochia, but mainly severe pain in the lower abdomen. It is often found that the cervix is soft, and the external cervix can pass at least 1 finger. The uterus is slightly softer than the normal uterus at the same time. Most uterus is posteriorly tilted and has a slight tenderness. If the factor is endometritis, the uterus When the uterus is incomplete due to myositis or pelvic infection, the uterine tenderness is more obvious, and even the attachment area has different degrees of tenderness. According to the above symptoms and signs, the diagnosis of uterine involution is not always possible. Great difficulty, but the diagnosis and identify the major causes of morbidity line by dilatation and curettage, scrapings help diagnose tissue sent to pathology, meanwhile, often have the aid of B-mode ultrasound examination.
Examine
Uterine incomplete examination
According to the condition, choose blood, urine, routine examination, B-mode ultrasound, see the uterus is large and there is residual placenta or residual fetal membrane image in the uterine cavity, you can diagnose the uterus caused by placental residue or residual membrane If the uterus muscle wall tumor or adenomyoma image is seen, the cause of uterine insufficiency can be confirmed.
Diagnosis
Uterine incomplete diagnosis and identification
diagnosis:
According to the symptoms and signs, it is not too difficult to diagnose the uterine involution, but the diagnosis and finding the cause of the disease mainly depends on the curettage, and the tissue will be sent to the pathological examination to help confirm the diagnosis. At the same time, it is often necessary to use B-mode ultrasound.
Differential diagnosis:
Mainly differentiated from postpartum infections and vaginal bleeding caused by other causes.
