What is the most common cause of subinvolution?
A.
Retained placental fragments
B.
Infection
C.
Uterine fibroids
D.
Multiparity
The Correct Answer and Explanation is:
The most common cause of subinvolution is A. Retained placental fragments.
Explanation:
Subinvolution of the uterus refers to the failure of the uterus to return to its pre-pregnancy size and condition within the expected timeframe after childbirth. This condition can lead to prolonged postpartum bleeding and other complications. Among the various causes of subinvolution, retained placental fragments are the most common.
- Retained Placental Fragments: After childbirth, the placenta should be expelled completely. If any fragments of the placenta or membranes remain in the uterus, they can prevent the uterus from contracting effectively. This results in subinvolution. The retained tissue can cause ongoing bleeding and increase the risk of infection and other complications. It is usually detected through symptoms like abnormal bleeding and is confirmed with ultrasound. Treatment involves removal of the retained fragments, often through a procedure called dilation and curettage (D&C).
- Infection: While infections, such as endometritis, can contribute to uterine subinvolution, they are not as common as retained placental fragments. Infection can cause inflammation and inhibit the uterus’s ability to contract and heal properly. However, this typically occurs after the initial period of postpartum recovery, making retained fragments a more immediate and prevalent cause.
- Uterine Fibroids: Uterine fibroids are benign tumors of the uterus that can affect its size and shape. While they can cause complications during pregnancy and childbirth, they are not commonly associated with subinvolution in the immediate postpartum period.
- Multiparity: Having multiple pregnancies does not directly cause subinvolution. However, it may increase the risk of uterine atony (poor uterine contraction), which could contribute to complications. Despite this, retained placental fragments remain the more common and direct cause.
In summary, retained placental fragments are the primary cause of subinvolution due to their direct interference with the normal uterine contraction process after childbirth. Proper management and removal of these fragments are crucial for effective resolution and recovery.