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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.
Uterine inversion is when the uterus turns inside out, usually following childbirth. [1] Symptoms include postpartum bleeding , abdominal pain, a mass in the vagina, and low blood pressure . [ 1 ] Rarely inversion may occur not in association with pregnancy .
Causes of postpartum hemorrhage are uterine atony, trauma, retained placenta or placental abnormalities, and coagulopathy, commonly referred to as the "four Ts": [12] Tone: uterine atony is the inability of the uterus to contract and may lead to continuous bleeding. Retained placental tissue and infection may contribute to uterine atony.
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.
Fundal massage, also called uterine massage, is a technique used to reduce bleeding and cramping of the uterus after childbirth or after an abortion.As the uterus returns to its nonpregnant size, its muscles contract strongly, which can cause pain.
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Obstetrical hemorrhage may be due to a number of factors such as placenta previa, uterine rupture or tears, uterine atony, retained placenta or placental fragments, or bleeding disorders. [71] Puerperal sepsis is an ascending infection of the genital tract. [72] It may happen during or after labour.