Variants of normal and pathological postpartum involution of the uterus

Аннотация

Objective: High frequency of disorders in the process of postpartum involution demands corrective therapy. A process of non-induced involution was studied in dynamics in 115 patients after spontaneous delivery at 36-40 weeks.

Полный текст

Methods: Clinical, bacteriological and ultrasonic (US) examination of the genitals was performed on the 1-3-5-7 and in some women on the 9-11-13 days after labor. In norm, the process of genital involution in different parts goes on synchronously with certain tempo.

Results: 3 variants of involution tempos were revealed: accelerated — in 5%, moderate — in 85%, decelerated — in 10%. In moderate and decelerated tempos, along with synergetic changes, dyscoordinated uterine involution was observed in 30%. The following types of dyscoordination were seen: 1) delayed involution of the uterine body with normal contraction of the rest parts; 2) delayed involution of the isthmian part; 3) delayed cervical formation; 4) early cervical formation. The 2nd, 3rd and 4th dyscoordination types were the cause or effect of development of puerperal diseases on a subclinical stage.

Conclusions: 1) About 70% of puerperants under the US control do not need uterotonic measures. 2) Dyscoordinated involution is the main US criterion of unfavorable postpartum course on a subclinical stage. 3) Uterine dimentions individually differed in the studied group by 2.5 times in the 1st day. Naturally, the involution of a “large” organ for the first 7-11 days is slower than that of a “small” one. This should be taken into account when using correlation tables.