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    Dr. Nur Asni-Uterine Subinvolusion

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    Yhaya 'Dzulhijjahyanti'
    This document discusses subinvolution of the uterus, which is a delayed involution of the uterus after delivery that can lead to prolonged bleeding. It notes that subinvolution and endometritis are common causes of secondary postpartum hemorrhage 1-2 weeks after delivery. The document provides guidance on differentiating and managing these conditions, including through the use of uterotonic drugs and antibiotics to help the uterus contract and treat any infection present. Surgical evacuation may be needed in some cases of subinvolution.

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    Dr. Nur Asni-Uterine Subinvolusion

    Uploaded by

    Yhaya 'Dzulhijjahyanti'
    2K views30 pages
    This document discusses subinvolution of the uterus, which is a delayed involution of the uterus after delivery that can lead to prolonged bleeding. It notes that subinvolution and endometritis are common causes of secondary postpartum hemorrhage 1-2 weeks after delivery. The document provides guidance on differentiating and managing these conditions, including through the use of uterotonic drugs and antibiotics to help the uterus contract and treat any infection present. Surgical evacuation may be needed in some cases of subinvolution.

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    meds obgyn

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    This document discusses subinvolution of the uterus, which is a delayed involution of the uterus after delivery that can lead to prolonged bleeding. It notes that subinvolution and endometritis are common causes of secondary postpartum hemorrhage 1-2 weeks after delivery. The document provides guidance on differentiating and managing these conditions, including through the use of uterotonic drugs and antibiotics to help the uterus contract and treat any infection present. Surgical evacuation may be needed in some cases of subinvolution.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    2K views30 pages

    Dr. Nur Asni-Uterine Subinvolusion

    Uploaded by

    Yhaya 'Dzulhijjahyanti'
    This document discusses subinvolution of the uterus, which is a delayed involution of the uterus after delivery that can lead to prolonged bleeding. It notes that subinvolution and endometritis are common causes of secondary postpartum hemorrhage 1-2 weeks after delivery. The document provides guidance on differentiating and managing these conditions, including through the use of uterotonic drugs and antibiotics to help the uterus contract and treat any infection present. Surgical evacuation may be needed in some cases of subinvolution.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 30

    Dr. St.

    Nur Asni, SpOG


    BAGIAN OBSTETRI DAN GINEKOLOGI
    FAKULTAS KEDOKTERAN UNIVERSITAS HASANUDDIN
    SUBINVOLUTION OF THE
    UTERUS

    The major cause of secondary


    postpartumhemorrhage
    SUBINVOLUTION OF THE UTERUS
    delayed involution of the uterus

    results in failure of obliteration of blood


    vessels at the placental site

    leading to prolonged bleeding


    Typically 1-2 weeks after delivery,
    up to 6 weeks PP
    Differential DX of increased lochia
    Sloughing of placental eschar (7-14 days)
    Retained placental tissue
    Endometritis
    Coagulopathy
    Subinvolution of uterus/placental site
    idiopathic, fibroids
    Recurrent clots a red flag
    Blood on foot sign
    Approach to persistent lochia:
    ?symptoms/signs anemia
    ?symptoms/signs endometritis
    Pelvic exam
    CBC, INR/PT/PTT
    Pelvic U/S
    Uterine involution
    The two main causes are
    DIFFERENTIATION BETWEEN THE
    TWO CAUSES IS OFTEN DIFFICULT

    BOTH CONDITIONS MAY


    CO-EXIST.
    Ascending polymicrobial infection
    Can lead to Sepsis!
    Significant source of mat. morbidity and
    mortality (3/100 000 deliveries)
    Symptoms: F/C, abdominal pain, malaise,
    +/- foul discharge, increased lochia

    Physical exam: VS, respiratory, breasts, abdomen,


    perineum

    Signs: look weak and ill


    febrile, tachycardic,
    fundal/abdominal tenderness
    poorly contracted uterus
    Endometritis usually follows
    Blood/tissue from placental site
    Normal is:
    Initial lochia rubra (days)
    Lochia serosa: red-brownish, watery (1-2 weeks)
    Lochia Alba: lighter, more mucus

    Typically lochia: 5 weeks, intermittent bursts


    -15% of women > 6 weeks
    RETAINED PLACENTAL TISSUE
    more common in

    a previous history of retained placenta


    OR
    if there were concerns of incomplete
    placenta and/or membranes.
    Fever in postpartum patient within 10 days
    of delivery is a medical emergency.
    Refer urgently to hospital

    > 7 daysconsider Chlamydia


    Tx: IV antibiotics (Clindamycin and
    Gentamicin +/- ampicillin)
    B/P and HR
    Diastolic BP 110 refer to hospital
    Distolic BP 90 x 2 r/a in 1 week
    PIH B/W
    Diastolic BP < 90 x 2 no TX

    If history indicates:
    weight
    Breast exam
    Signs of hyper-/hypothyroid disorder
    Offer to all asymptomatic women
    Advise if hx perineal tear/episiotomy
    Absolute must:
    persistent lochia
    abnormal discharge
    incontinence
    repeat Pap smear needed
    Considering IUDneed swabs + uterine position
    Initial
    management should include
    RESUSCITATION

    Use UTEROTONIC AGENTS

    Administer ANTIBIOTICS

    Consider SURGICAL EVACUATION OF THE


    UTERUS
    Early recognition of PPH is a very important
    factor in management.

    An established plan of action for the


    management of PPH is of great value when
    the preventative measures have failed.
    MANAGEMENT - ABCS
    talk to and observe patient
    large bore IV access (16
    gauge)
    crystalloid - lots!
    CBC
    cross-match and type
    get HELP!
    AIRWAY
    Management - Oxytocin
    5 units IV bolus
    20 units per L N/S IV wide open
    10 units intramyometrial given
    transabdominally
    Management - Uterotonics
    Ergotamine - caution in
    hypertension
    0.25 mg IM or 0.125 mg IV
    maximum dose 1.25 mg
    misoprostol)- caution in asthma
    400 mg pr or po
    VAGINAL DELIVERY - mild ENDOMETRITIS:
    Single broad spectrum antibiotic (eg.
    Ampicillin 1 g IV q6h OR orally)

    if CESAREAN SECTION:
    Metronidazole 500 mg q8h + Cefotaxim 2g
    q6h
    OR
    Aminoglycoside (Gentamycin) 60-100 mg q8h +
    Clindamycin 900 mg q8h
    if IV antibiotics used, continue for 48
    hours after fever has stopped.
    if fever continues and aminoglycoside-
    clindamycin combination was used,
    add penicillin (5M units q6h) to cover
    enterococci
    PO antibiotics should be used for 5
    days
    The more antibiotics used, the higher
    the chance of necrotizing colitis

    Antibiotics do appear in breast milk


    but in most cases are not significant
    (avoid tetracyclines)

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