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The uterine height is greater than the normal for the particular day of puerperium. Normal puerperal uterus may be displaced by a full bladder or a loaded rectum. It feels boggy and softer upon palpation. The presence of features responsible for subinvolution may be evident.
Uterine distention caused by things like more than one fetus present, polyhydramnios, fetal macrosomia, uterine fibroids, chorioamnionitis can also lead to decreased uterine function and atony. Retained placental tissue or placental disorders, such as an adherent placenta, placenta previa , and abruption placentae increase the mother's risk of PPH.
Risk factors include pulling on the umbilical cord or pushing on the top of the uterus before the placenta has detached. [1] Other risk factors include uterine atony, placenta previa, and connective tissue disorders. [1] Diagnosis is by seeing the inside of the uterus either in or coming out of the vagina. [2] [6]
Routine use of fundal massage can prevent postpartum or post-abortion hemorrhage and can reduce pain; it may also reduce the need for uterotonics, medications that cause the uterus to contract. It is used to treat uterine atony, a condition where the uterus lacks muscle tone and is soft to the touch instead of firm. [1]
Involution is the shrinking or return of an organ to a former size. At a cellular level, involution is characterized by the process of proteolysis of the basement membrane (basal lamina), leading to epithelial regression and apoptosis, with accompanying stromal fibrosis.
Post-partum hemorrhage is usually attributed to uterus atony, when the uterus fails to contract after delivering the baby. [25] As a result of discrepancies in diagnostic criteria and human variability, there is wide variation in data on maternal and fetal death associated with poor progress. [19]
Fetal resorption (also known as fetus resorption) is the disintegration and assimilation of one or more fetuses in the uterus at any stage after the completion of organogenesis, which, in humans, is after the ninth week of gestation.
Retained placental tissue and infection may contribute to uterine atony. Uterine atony is the most common cause of postpartum hemorrhage. [13] Trauma: Injury to the birth canal which includes the uterus, cervix, vagina and the perineum which can happen even if the delivery is monitored properly. The bleeding is substantial as all these organs ...