09.04 Subinvolution

Overview

  1. Subinvolution is a medical condition in which after childbirth, the uterus does not return to its normal size.

Nursing Points

General

  1. Fundal height normally drops by 1 cm below the umbilicus per day postpartum
  2. Contraction of uterus clamps down and prevents bleeding
  3. Subinvolution = Large risk of postpartum hemorrhage

Assessment

  1. More uterine bleeding than expected
  2. Fundal height not decreasing as expected
  3. Uterus larger than expected

Therapeutic Management

  1. Treat the cause
    1. Remove retained fragments
    2. Treat infection
    3. Get the uterus to contract
  2. Medications to contract the uterus
    1. Oxytocin
    2. Methylergonovine
    3. Carboprost Tromethamine

Nursing Concepts

  1. Clotting
  2. Perfusion
  3. Safety

Patient Education

  1. Report any pain greater than usual when palpating
  2. Report frequent saturation of pads

Reference Links

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Video Transcript

In this lesson I will explain subinvolution and your role in caring for this patient.

So what is subinvolution and what is the big deal?. Subinvolution occurs after childbirth when the uterus does not return to its normal size. So normally we have a uterus and it carries a baby and grows larger and larger right? Then the baby is born and that uterus goes way down to around the umbilicus and then slowly moves down 1 cm each day. Well that is the normal situation and here our patient has subinvolution. So the uterus does not make its way back down into the pelvis the way that it should. This could be because of retained placenta, overdistended uterus from carrying multiples or many pregnancies, and the biggest cause is uterine infection. So all of these items are causes.. So remember the fundus is not contracting and moving down the way that is should so it puts the patient at risk for postpartum hemorrhage.

Assessment of this patient will be more uterine bleeding than expected. The fundal height is not going to be decreasing as expected so because of this the uterus is larger than expected.
So management of this patient is going to be to fix the cause. So if the subinvolution is happening because there is retained placental parts then the retained pieces need to be removed. A huge cause of subinvolution is infection so if there is a uterine infection then we of course want to treat that with antibiotics. We can also give medications to contract the uterus. If we can get it to contract it will clamp down and move towards the pelvis where it should be. So medications are methylergonovine, carboprost tromethamine, and oxytocin.
Ok so onto our patient education. You will educate this patient on a couple things. If the pain is worse than usual on palpation of the uterus she should report it. This pain can indicate there is a uterine infection which would cause subinvolution to occur. We also really need them to report if they are frequently saturating their pads. So any heavy bleeding, we want to know about that!
Our concepts are clotting, perfusion, and safety because of the increased bleeding risk and danger that subinvolution can cause.
Alright let’s review this. So subinvolution is when the uterus doesn’t contract properly post delivery and move down into the pelvis. This can be caused by a uterus that has been over distended. So perhaps from carrying multiples or been through multiple pregnancies. It is just overstretched. It could also be from retained placenta, which is going to cause bleeding or from a uterine infection. With the infection there is inflammation so the uterus is larger. Our treatment will be to fix whatever the cause is. So it might be we need it to contract more so we give medications for that, our methylergonovine, carboprost, or oxytocin. If there is retained placenta then we need to get that removed. If there is an infection then we need to treat that with antibiotics.

Make sure you check out the resources attached to this lesson adn review treatment for subinvolution. Now, go out and be your best selves today. And, as always, happy nursing.

Read more

  • Question 1 of 7

A nurse works in a busy postpartum unit caring for new mothers and their babies. Which of the following situations would most likely warrant a call to a provider for further orders for care or treatment?

  • Question 2 of 7

A nurse is assessing 4 postpartum clients. Which of the following clients is the most concerning?

  • Question 3 of 7

A nurse is caring for a client who underwent a procedure to remove fragments of retained placenta after a vaginal delivery. Which of the following nursing actions would be priority for this client?

  • Question 4 of 7

A nurse is performing a postpartum assessment on a client who is postpartum day 2 and her fundus is at U-2. The nurse knows this is indicative of what condition?

  • Question 5 of 7

You suspect your patient is suffering from subinvolution. Which of the following would NOT be an appropriate intervention? Select all that apply.

  • Question 6 of 7

A nurse is caring for a postpartum client who delivered vaginally a day ago and now has aches and chills and complains of pain during palpation of the uterus, which sits at U+1. Which condition should the nurse be most concerned for?

  • Question 7 of 7

A nurse is educating a postpartum client on the expectations for involution of the uterus. The nurse knows that which of the following conditions would put the client at higher risk for subinvolution?

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