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Involution of The Uterus

This document discusses the physical and physiological changes that occur in a mother's body during the postpartum period known as puerperium. It covers hormonal changes, breast milk production, uterine involution, lochia discharge, and management of common issues.

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landegre K
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22 views

Involution of The Uterus

This document discusses the physical and physiological changes that occur in a mother's body during the postpartum period known as puerperium. It covers hormonal changes, breast milk production, uterine involution, lochia discharge, and management of common issues.

Uploaded by

landegre K
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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MID 304/ SESSION 2

PHYSICAL AND
PHYSIOLOGICAL CHANGES
AND ITS MANAGEMENT IN
MOTHER
OBJECTIVES
1. Recognize the anatomical & physiological changes occuring
during puerperium.
2. List down the hormones responsible for physiological changes.
3. Explain the physiology of breast milk secretion and the hormones
responsible for it.
4. Explain involution of uterus and the anatomical changes that
occurs in the process.
5. Explain Lochia and the types of lochia and explain their clinical
significance in the puerperium.
6. List down the causes of soft tissue injuries and trauma.
7. Mx. of injuries and trauma occurring during the puerperium
period.
8. Explain other general physiological changes in the puerperium
PUERPERIUM
Definition: Puerperium is the period following childbirth
during which the body tissues, especially the pelvic
organs revert back approximately to the pre-pregnant
state both anatomically and physiologically.
It begins as soon as the placenta is expelled and lasts for
approximately 6 weeks when the uterus becomes
regressed almost to the non-pregnant size.
It is individually divided into three phases:
1. Immediate-within 24 hours.

2. Early – up to 7 days and

3. Remote – up to 6 weeks.
1. HORMONAL & SYSTEMIC CHANGES
 Estrogen & Progesterone decreases markedly after the expulsion of
the placenta reaching their lowest levels by one week in the post
partum period. That is why during pregnancy, high level of
Placental progesterone have a negative impact (inhibits)
lactogenesis.
 However, the estrogen level in the non-lactating women begin to
increase by 2 weeks after birth and reaches its maximum by day 17.
 After birth, oxytocin is secreted by the posterior pituitary gland to
act upon the uterine muscle (contract) and assist in the separation of
the placenta. Excretion and ejection of milk is also done by the
hormone oxytoxin.
 In women who breastfeed, Prolactin levels remain high into the 6th
week and thereafter. In non-lactating women, prolactin levels decline
reaching the pre-pregnant range by the 3rd week of puerperium.
 During pregnancy, thyroid gland increase by 13% due to vascularity
& glandular hyperplasia and the volume increases by approximately
30%. During puerperium, this returns to normal over a 12-week
period. Thyroxine and triiodothyronine return to normal within 4
weeks post-partum.

II: LACTOGENISIS

Refer last years session on Mammary glands and the Physiology of


Milk secretion (Read PED301/ Session 9/ Lactogenisis/ Breast
feeding problems & their solutions)
III: INVOLUTION OF THE UTERUS
 Def: Involution is a process whereby the reproductive organs
return to their non-pregnant state.
 The puerperium/ post-partum period begins as soon as the
placenta and the membranes are expelled and lasts approximately
for six weeks until the uterus has regressed to its non-pregnant
stage. The WHO recommends post natal contacts at 24 hrs after
delivery, after 3 days, at 1-2 weeks, at 3 weeks and at 6 weeks.
A: Involution of the uterus: Anatomical changes
 Following delivery, the uterus begins to contract, becomes firm
and retracted (contract).
 Immediately following delivery, the uterus weighs appx. 1 kg and
measures 20 x 12 x 7.5 cms (L, B, thickness) and the fundus can
be palpated at or just below the umbilicus.
 By the end of 1st week it weighs around 500 gms and by the end of
puerperium, it usually returns to its non-pregnant weight of 60
gm.
 The fundus descends at the rate of 1cm/1finger breadth or ½ inch
every day and by the end of day 10th- 14th, it will descend in the
pelvic cavity.
 The cervix contracts slowly & the external os admits two fingers
for few days & by the end of 1 week it narrows down to admit
only the tip of a finger
 When the uterus fails to undergo involution, it is known as
subinvolution
Physiological changes of the involution
 Mostly seen at the body of the uterus

A. Muscles:

1. Marked hyperplasia & hypertrophy during pregnancy and


muscle fibers increases 10 times in length & 5 times in
breadth.
2. During puerperium, muscle fibres not decreased but
myometrial cell size are largely reduced.
3. Withdrawal of steroid hormone oestrogen & progesterone
lead to increase in the activity of uterine collagenese
resulting in the release of proteolytic enzyme.
4. Involution takes places by ‘autolysis’ where the collagen
fibres are digested by the proteolytic enzymes and the end
products are removed by the phagocytic action of the
macrophages and polymorphs in the blood and lymphatic
system.
 In women who choose to breast feed, suckling of the
infant stimulates further secretion of oxytoxin which
expedites involution.
 Involution of the uterus can sometimes cause painful
uterine contractions called as ‘afterpains’.
 Regeneration of the endometrium starts by 7th day.
 Regeneration of the epithelium is completed by 10th day
and the entire endometrium is restored by the day 16,
except at the placental site where it takes about 6 weeks.
PROGRESSION OF CHANGE IN THE UTERUS AFTER DELIVERY

Postpartum Wt. of uterus Diameter of Cervix


day/week placental site

End of labour 900-1 kg 12.5 cms Soft, flabby

End of week 1 450-500 gms 7.5 cms 2cms

End of week 2 200 gms 5.0 cms 1 cm

End of week 6 50-60 gms 2.5 cms A slit


B: Physiological changes in the Endometrium &
Lochia
 The superficial layer which becomes Ischemic &
necrotic is sloughed off as lochia
 Lochia is the term used to describe the discharges
from the uterus, cervix & vagina during the
puerperium.
 It is alkaline in nature and organisms can grow much
rapidly than the normally acidic vagina.
 Heavy odour (fishy) and the amount can vary in
individual women. Undergoes squential changes in
colour as involution progresses
I. Lochia Rubra (Red): First 3-4 days of the
puerperium. Consists of blood from the placental site,
debris arising from the decidua and chorion, shreds of
fetal membrane, lanugo, vernix caseosa.
II. Lochia serosa (pink/pale brownish) Next 5-9 days.
Have less blood and more serum and contains
leucocytes from the placental site, wound exudates,
mucus from the cervix & anaerobic microorganisms
Streptococci & Staphylococci)
III. Lochia alba (white): 10-15 days and sometimes
beyond. Pale, creamy brown in colour, contains
leucocytes, cervical mucus and debris from healing
tissues. In some women, normal duration may extend
up to 3 weeks sometimes
Clinical aspect/significance of lochia
 Presence of small blood clots may be normal during the
first 24 hrs especially in multiparous women. But if this
continues or is accompanied by pain, it is suggestive of
retained products of conception.
 Persistence of red lochia means sub-involution

 Offensive lochia may indicate infection or poor perineal


hygiene
 In severe infection, the lochia may remain offensive and
scanty. May lead to puerperal sepsis if not treated in time.
 Amount: The average amount of discharge for the first 5–
6 days is estimated to be 250 mL
 Duration: Duration of the lochia alba beyond 3 weeks
suggests local genital lesion.

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