How much the uterus contracts after childbirth in first-time mothers. The process of uterine contraction after childbirth - how it happens and how long it lasts. Physical recovery methods

During pregnancy, a woman regularly thinks about childbirth. The expectant mother imagines this process and studies a lot of information on this topic. During this period, the pregnant woman most often does not worry about what will happen to the body after the baby is born. And this is not entirely correct. This article will tell you about how uterine contractions occur after childbirth. You will find out how long the pain will last. It is also worth saying about discharge during this period.

Painful contractions of the uterus after childbirth, or rejection of the placenta

When the fetus is removed from the cavity of the reproductive organ, many women believe that labor is over. However, only the second period of this process can be considered completed. In just a few minutes, uterine contractions will begin after the baby is born. This is necessary for the rejection of the baby's place, or placenta. It is also often called the afterbirth. Women note that these contractions are not so strong in terms of pain intensity. And they are quite easy to carry.

After the birth of the placenta, we can consider that the process is completely completed. The doctor carries out the necessary hygienic procedures and leaves the woman in labor to rest. However, literally within a few hours, contractions of the uterus will begin after childbirth, which are often called postpartum contractions.

Why are uterine contractions necessary?

During pregnancy, a dramatic restructuring of the functioning of all organs and systems of a woman occurs. The reproductive organ is particularly affected. It stretches and increases in volume. The looms are thinning and preparing for the arrival of the child.

After childbirth, the reverse process of transformation must occur. Contraction of the uterus after childbirth occurs spontaneously in most cases. It is painful in the first week. During this period, a woman may note that she feels periodic contractions. What is the duration of uterine contraction after childbirth? We will also consider allocations further.

The first 7 days after the baby is born

After childbirth, a woman feels contractions of the uterus especially strongly. On the first day, the reproductive organ weighs about 1000 grams. In this case, the pharynx is opened by 8-10 centimeters. Painful sensations are especially felt during breastfeeding or nipple stimulation. Also, in some cases, doctors prescribe injections with oxytocin. This drug is especially often recommended for women with multiple or polyhydramnios pregnancies. What can be said about discharge during this period?

Postpartum bleeding begins immediately after the placenta is delivered. In the first week it is more abundant and has a bright red color. It is worth noting that ordinary hygiene products cannot always cope with such secretions. That is why special ones were invented for women

Second week after birth

During this period, contraction of the uterus after childbirth continues. However, women no longer feel this process so strongly. At this stage, the reproductive organ weighs about 500 grams and is already placed in the small pelvis. If a woman is still taking oxytocin, she may notice a slight nagging pain in the lower abdomen immediately after taking it.

Contraction of the uterus after childbirth (in the second week) also provokes discharge. During this period, they become less abundant and acquire a pale tint. The blood no longer looks like menstrual blood, it begins to gradually thicken.

Third and fourth weeks after birth

This period is characterized by the weight of the uterus being 300-400 grams. She still needs to contract. However, the new mother no longer feels pain. Sometimes she may notice that the lower abdomen becomes hard and there is discharge. Most often this happens during breastfeeding.

The discharge at this stage is already quite light and more reminiscent of orange-pink water. It is worth noting that lochia has a specific odor. However, it should not be harsh and unpleasant.

A month after giving birth

During this period, the weight of the uterus ranges from 50 to 100 grams. The reproductive organ has almost returned to normal and has shrunk. However, the reduction continues. Most often it happens completely unnoticed by the woman.

The discharge during this period practically ended. However, in some women they can last up to 6-7 weeks after the birth of the baby. This period depends on how the pregnancy progressed and whether there were any complications.

Special cases and complications

It also happens that it occurs. Most often it is caused by abnormal sizes of the reproductive organ, cesarean section, lack of breastfeeding, and so on. At the same time, the woman notes very heavy discharge and daily increased bleeding. Also, a new mother may notice the absence of lochia. This indicates a blockage. Most often this happens after the birth of a child via cesarean section.

If a complication such as placental rejection occurs during the birth process, the woman undergoes surgery. In especially severe cases, it requires complete removal of the reproductive organ. It is also performed in case of growth of a child’s place into its wall. However, the timing will be slightly different. In this case, contractions do not occur at all, since the organ is removed. However, there is bloody discharge after the operation. They can last no more than one week, but should decrease every day.

If the placenta is retained in the uterine cavity, then most often the woman is prescribed curettage. It is performed under anesthetic a few days after birth. After it, the intensity of discharge and the timing of contraction of the reproductive organ may be less. This is because most of the mucus and blood were separated using medical instruments.

How does the uterus contract after the second birth?

Some women believe that having a child again increases the duration and contractility of the reproductive organ. However, doctors completely refute this statement.

The timing and intensity of uterine contractions directly depends on the course of the pregnancy. In this case, the previous number of births does not matter at all.

Is it possible to speed up the process?

So, you know how the uterus contracts after childbirth. The timing of this process is described above. In order for the reproductive organ to quickly return to its original size and get rid of lochia, you must follow some rules.

Put your baby to your breast more often. Regular sucking movements stimulate the nipples. This leads to the production of the hormone oxytocin, which is responsible for contractility and strength.
Use prescribed medications. If your doctor has prescribed you certain medications, you should not neglect them. Intramuscular or sublingual use of oxytocin is most often recommended. The correction is carried out within three days to two weeks.
Avoid overheating. Avoid hot tubs and saunas. All this can provoke increased bleeding and weak contractility of the uterus.
Maintain good hygiene. This will help prevent pathogenic microbes from entering the uterus, which cause inflammation and inhibit contractions.
Lie on your stomach. Many doctors recommend this position to prevent kinking of the isthmus of the genital organ, which can cause stopping of discharge and blockage of the cervical canal.
Wear a postpartum bandage. This device will help the uterus recover faster by properly fixing it.

So, you now know the timing of discharge and painful contractions of the reproductive organ after childbirth. If there is a strong deviation from the described phenomena, then you should consult a doctor. This will help you avoid complications in the future. Be healthy!

During pregnancy, the female body is subject to various changes. Hormonal levels change, the uterus enlarges, the belly grows, and the breasts swell. Contraction of the uterus after childbirth is a natural recovery process of the body, which can last from 5 weeks to several months.

How does the uterus feel after childbirth?

A woman’s body is individual, and therefore the process of uterine restoration has different timing. There are certain norms that are considered standard.

After liberation from the fetus, the uterus is greatly stretched with a wound surface at the placenta attachment site. The wound bleeds, releasing lochia, which contains fragments of the placenta, mucus and blood from ruptured vessels. In the first days, the uterus is sterile due to the absorption of bacteria by leukocytes.

The strongest contractions and heavy discharge occur during the first 4-6 days after birth. In this case, the organ initially weighs 1 kg. After 15 days, the weight will decrease by 700 grams, and after 6 weeks it will weigh only 70 grams.

Table of the process of uterine contraction:

After the birth of the baby, the cervix is dilated and reaches 12 centimeters. If necessary, the doctor inserts an arm to clean out any remaining placenta. In the third week, the cervix closes completely.

As the uterus contracts, the bleeding vessels are compressed and dry out, and bleeding stops along with them.

Young mothers are concerned about the question: how long does it take for the uterus to contract?

Some physiological factors influence the rate of reduction:

Woman's age;
Number of pregnancies;
Child sizes;
Location of the placenta;
Number of newborns.

On average, the uterus returns to normal in 5 to 8 weeks. The most significant changes occur for the first 10 days.

If the suckers end by the end of the 6th week, it means that the woman’s body has worked normally. For a longer period, it is necessary to notify a specialist about the condition.

The birth of a baby is the beginning of a lot of work for the body to restore its normal, “normal” functioning. It is not without reason that doctors emphasize the importance of this period for the female body. Contractions of the uterus after childbirth mark the beginning of recovery processes, and for their complete completion it will take at least 6-8 weeks.

So much has already been written about pregnancy and childbirth that everyone can find the information they are interested in. But they happily forget about this difficult and important period, believing that a successful birth is a complete end, this is a happy happy ending. Today we want to dwell in detail on what happens in a woman’s body when the baby leaves her body, and how the process of returning to normal functioning occurs.

First changes

Usually the first thing women in labor feel is uterine contractions. After childbirth, within three days, they will gradually reduce their intensity, and the stretched dimensions of this muscular organ will return to normal. However, changes occur that are less noticeable to the naked eye:

Throughout the 40 weeks of pregnancy, serious changes were observed in the functioning of the cortex and subcortex of the brain - this was important for its preservation. And now pregnancy hormones begin to be removed from the body, and the endocrine system is restored.
The volume of blood in the body decreases.
The kidneys begin to work more actively, removing metabolites.
Contractions of the uterus after childbirth are wave-like. And a woman feels discomfort from time to time, which is the absolute norm. By the end of the 8th week after birth, the uterus acquires the size of a non-pregnant one. Don't try to put on your favorite trousers early - everything will soon return to normal. Separately, I would like to say about the condition of the uterine cavity, which is a wound. A new endometrium will gradually form on it.
Contractions of the uterus after childbirth are also important for the tone of the pelvic floor muscles. At the same time, the vagina is being restored every day. Cracks and tears received during childbirth gradually heal, and the abdominal wall is strengthened due to the same muscle contractions.

New sensations

Immediately after the baby is born, the mother feels very tired and drowsy. But overall her condition is satisfactory, her body temperature is normal. Contractions of the uterus after childbirth are periodically felt in the form of pain that resembles weak contractions. In firstborns, this process goes almost unnoticed, and after the second, the uterus contracts more painfully. And to make this process go even faster, you need to put the baby to the breast as often as possible. Nipple stimulation increases the level of natural oxytocin in the blood. As a result, the uterus returns to normal faster.

Must know

During the period described, you need to force yourself to go to the toilet, since it is extremely undesirable to endure it. In addition, a woman, as a rule, has swelling of the neck of the bladder because during childbirth it was squeezed by the baby's head. Because of this, during the first urination the sensation may not be the most pleasant. To make this process more active, you need to move as much as possible.

In a full state, the bladder will interfere with physiological contractions. If this cannot be done naturally within 8 hours, then doctors use a catheter.

Second birth: recovery time

Indeed, uterine contractions after the second birth often occur somewhat faster. Intense pain may be felt during the first 3-4 days. By the time of birth, the uterus reaches a weight of 1 kg, while in 6-8 weeks it will have to shrink again to 70-80 g. Every day its volume decreases by about 2 cm. However, as we have already said, in multiparous women the uterus is already familiar with its work and contracts more actively, returning to its original form. If a woman led an active lifestyle, walked a lot, then most often no problems arise at this stage.

Full recovery

It’s not for nothing that doctors recommend sexual rest for the first two months after the baby is born. In the first days, the muscles are actively involved in work to return the organ to its previous state. Hormones play an important role in this. The diameter of the uterus after childbirth is 12 cm; the gynecologist can insert a hand to examine and remove the placenta. Within a day, the cervix shrinks to 2 fingers. By the end of the third day, its width will be only the thickness of one finger. Complete closure occurs by the end of the third week.

The weight of the muscle organ changes no less quickly. On the first day after expulsion of the fetus, it weighs at least 1 kg, after a week the weight is halved, after three weeks it is about 350 g. In a month and a half, the uterus will again become a small muscular sac weighing 50 g.

If the natural forces of the body are not enough

It also happens that the uterus does not contract after childbirth. The pain in this case may be even stronger than usual, but as a result the organ retains its pregnant size. This condition is called muscle atony. That is, for a number of reasons it does not contract, which leads to heavy uterine bleeding. Very rarely, this condition occurs in young women. Atony is characteristic of polyhydramnios, the birth of a large child or multiple births.

There are other situations when the uterus contracts, but too slowly, doctors diagnose “hypotension.” It is completely correctable, but requires careful attention from medical professionals. It should be noted that both of these conditions are quite dangerous for the health of the mother. They can cause severe bleeding and a number of other complications.

What are the reasons for such violations

Doctors know well how to diagnose and treat uterine atony and hypotension. And a number of factors lead to this. And it is not always possible to predict in advance that such a complication may occur after childbirth. However, the most common reasons are:

multiple births;
position of the placenta;
the woman’s condition, general decreased tone;
various complications.
large fruit.

In some cases, contraction of the uterus after childbirth is completely impossible. These are options for underdevelopment of the uterus, its kinks, polyhydramnios, trauma to the birth canal, as well as inflammatory processes in the uterus itself or its appendages. We observe similar complications with blood clotting disorders. But this can be foreseen in advance and the necessary measures can be taken.

How to help a woman in labor

Today, medicine has a whole arsenal of methods that can stimulate regenerative processes in the female body. The very first remedy used in maternity hospitals is a cold heating pad. It is applied to the mother's belly. This speeds up contractions and stops bleeding. Previously, this was practiced in relation to all women, but today it is selective - only when necessary.

From the very first minutes of the baby's birth, it is recommended to put him to the breast and not take him away for the first 2-3 hours. Then the baby must suck all the time he is awake. This stimulates the normalization of hormonal levels, and natural oxytocin will be an excellent tool for quick recovery.

There are other ways to stimulate uterine contractions after childbirth. The doctor working in the maternity hospital will definitely tell you how to speed up this process. It is recommended to move a lot and lie on your stomach during breaks. Go to the toilet to empty your bladder as often as possible. Even if it becomes painful after childbirth, try not to restrain yourself.

Introduction of artificial hormone

As we have already said, oxytocin is a hormone that is produced by the hypothalamus and accumulates in the pituitary gland. Its active production after childbirth has the following functions:

it perfectly tones the muscles of the uterus;
it is under its influence that breast milk begins to be produced;
the hormone acts on the body as an antidepressant.

If the body itself, for one reason or another, cannot produce a natural hormone, then oxytocin is administered artificially after childbirth to contract the uterus.

Late complications

Sometimes in the first days after childbirth, the recovery process goes well, the woman is discharged home, and then a problem arises. If there is a blockage of the uterine pharynx, this can lead to serious complications, and you should resort to cleaning. Delay can be very dangerous. An inflammatory process may begin. To avoid this, sometimes the doctor gives an injection to contract the uterus after childbirth. However, such a decision is made individually.

Blockage and subsequent inflammation can occur a week after the baby is born. Symptoms include fever, aching pain in the lower abdomen, and an unpleasant odor of discharge. In this case, the patient is sent for an ultrasound, and if the diagnosis is confirmed, surgery is performed.

You can do a lot on your own

In fact, a woman in labor can help restore her body. Exercises to contract the uterus after childbirth will help you get in shape much faster:

You will need to lie on the floor, on your side. Bend your legs at the knee joints, place one hand under your head, and rest the other on a sofa or other stable object. Now start lifting your pelvis. Repeat 8-10 times and turn over to the other side.
Get on all fours and, as you exhale, draw in your stomach.
Tighten the muscles of the perineum and pelvis. Try to use your muscle strength to stop the stream of urine in the toilet and hold it for 8 seconds.

These simple exercises will allow you to recover much faster and without complications. In addition, moderate physical activity during pregnancy also contributes to the normal process of childbirth and speedy recovery after it. And painful contractions of the uterus after childbirth are a normal phenomenon, which indicates the restoration of the natural functioning of the body.

The female body does not return to normal after childbirth immediately: gradually over several months. The uterus, which “grows” together with the baby, “gets” the most (this organ can increase more than 500 times), so it is injured the most. To restore the uterus after childbirth, proper care, time, and supervision by a gynecologist are required.

The uterus gradually begins to contract after the birth of a child, and this process is purely individual for each woman, since each body needs “its own” time to recover.

What is the uterus like after childbirth?

From the inside, the uterus after childbirth looks like a huge wound, which is maximally damaged at the placenta attachment site. In addition, blood clots and remnants of the fetal membrane remain on its inner surface. The uterine cavity should normally clear out during the first 3 days after birth.

After childbirth, the uterus stretches and increases in volume. Lochia (postpartum discharge) is released from it, bloody in the first days, lighter by the 4th day, by the end of the 3rd postpartum week they become more and more liquid and lighter and disappear completely by the 6th week.

We can talk about the restoration of the inner lining of the uterus after childbirth no earlier than the 3rd week, and about the placenta attachment - at the end of the postpartum period.

The fundus of the uterus after childbirth is located 4-5 cm below the navel and, like its upper part, has the greatest thickness.

How long does it take for the uterus to contract after childbirth?

Usually this process takes 1.5-2.5 months, and it is most active during the first postpartum days. For example, the diameter of the uterine os immediately after childbirth is approximately 12 cm, as a result of which the gynecologist can insert his hand into the uterus to remove any remaining placenta. But by the end of the first two days, this “entrance” gradually narrows, due to which only 2 fingers can be inserted into the uterus and 1 on the third day.

Complete closure of the external uterine os occurs around the 3rd week.

The weight of the uterus after birth is 1 kg. On the 7th day, she already weighs about 500 grams, on the 21st - 350 grams, and closer to the end of the postpartum period, the uterus returns to its prenatal size (approximate weight 50 grams).

During the process of contraction of the uterus after childbirth, women feel slight cramping pain in the lower abdomen, which is more intense and pronounced after repeated births. If these contractions are accompanied by severe pain, you should first consult a doctor, after which he will be able to prescribe the necessary antispasmodic or analgesic to reduce the pain. But if possible, it is better to endure everything and do without medications.

Atony and hypotension of the uterus after childbirth

Unfortunately, not all women in labor have a contraction of their uterus after childbirth. This condition is called uterine atony (in other words, it is a direct consequence of the fatigue of its muscles), as a result of which it does not contract and uterine bleeding occurs. Atony most often occurs in multiparous women, also during the birth of a large fetus, or with multiple pregnancies.

In the case when the uterus contracts after childbirth, but very slowly, the mother in labor is diagnosed with hypotension. This is a condition in which contractility and contractility are sharply reduced.

Both of these conditions of the uterus after childbirth are equally dangerous for the health of the mother in labor, as they can provoke massive bleeding or cause a number of other complications.

Reasons for non-contraction of the uterus after childbirth

There are a number of factors that can prevent or promote faster uterine contractions after childbirth.

The most common among them are:

multiple births;
location of the placenta;
general condition of the woman;
difficulties encountered during pregnancy or after childbirth;
high fetal weight.

There is no spontaneous contraction of the uterus after childbirth in cases of its underdevelopment or bending; at ; for injuries of the birth canal; with inflammatory processes in the uterus itself or its appendages; in the presence of a benign tumor (fibroma); for bleeding disorders, etc.

What to do if the uterus contracts poorly after childbirth?

Immediately after the baby is born, a cold heating pad should be applied to the mother's belly, which will help speed up uterine contractions and stop bleeding.

During the first days after giving birth, the young mother is in the maternity hospital under the constant supervision of doctors, who must regularly check the condition of the uterus, as well as the level of its contraction. A low ability of the uterus to contract can be diagnosed by a gynecologist based on the condition of its fundus, which in this case should be soft during a routine examination. Until then, the doctor cannot discharge a woman from the maternity hospital until he is completely sure that the uterus is contracting normally.

If the uterus cannot contract on its own, the gynecologist should prescribe special medications (oxytocin or prostaglandins) that enhance the contractile activity of its muscles. Massage of the fundus of the uterus (externally) can also be prescribed.

But the most important impulse that stimulates uterine contractions after childbirth is breastfeeding, so start breastfeeding as quickly as possible.

Do not neglect the rules of personal hygiene: regularly wash and treat wounds.

Empty your bladder on time, which also has a great influence on the degree of uterine contraction. Even if you have had internal stitches and urination has become painful, try to go to the toilet as often as possible.

The uterus contracts better and faster after childbirth in those women who have not avoided light physical activity throughout their pregnancy, so walks in the fresh air are beneficial for pregnant women. Don't avoid simple homework. Simple gymnastic exercises will not be superfluous either.

If there are lochia left in the uterus, part of the placenta, or the uterine pharynx is clogged with blood clots, you should resort to cleansing, without which an inflammatory process may begin.

Especially for Anna Zhirko

Immediately after the baby leaves the uterus during childbirth, the process of reverse development of the female reproductive organ begins. During pregnancy, the uterus grows almost 500 times. It is clear that she cannot immediately decrease to her original size after giving birth.

We will talk about how the process of reverse development proceeds, what can affect it and what violations there may be in this article.

What happens normally?

The process of reverse development of the reproductive organ in women after the birth of a child is called involution in medicine. Involution is a term that does not mean anything pathological, it is a description of the process and nothing more. The uterus fulfilled its task - it helped to bear and give birth to a child. Now her task is to return to the original parameters, restore functions so that the woman becomes fertile again and can conceive, bear and give birth to the next baby.

In primiparous and multiparous women by time The involution process normally lasts about 6-8 weeks. This is a complex and multi-step process. Immediately after the baby is born, the uterus weighs about a kilogram, its volume is normally in the range of 4900-5250 ml, the length of the uterus (if you immediately measure it on an ultrasound) is about 22-25 centimeters, and in diameter it is almost 15 centimeters . The uterus is located above the pelvis and is essentially an empty sac from which all the contents have been removed.

It should be noted that before pregnancy, the female uterus has a very small volume (no more than 5 ml), and the weight of the reproductive organ is 60-70 grams. To reach such a size again, the uterus and the entire female body will have to “try.”

What happens inside the reproductive organ? The fibers of the uterine tissue (myometrium) gradually shrink. Most this process occurs intensively in the first 3-4 days after the birth of the child, but even then the involution does not stop. When stretched, overgrown fibers contract, the blood vessels narrow.

Gradually, their complete closure occurs, and the fibers that have become unnecessary die off and come out in the form of lochia - bloody postpartum discharge with clots. If one part of the decidual layer is torn away during contraction, then the second remains to become the basis for a new endometrial layer.

Involution begins immediately after the placenta (afterbirth) leaves the uterine cavity.

The process is largely due to changes in hormonal levels: low amounts of progesterone and high oxytocin in the blood of the postpartum woman ensure the contractility of the reproductive organ.

During involution, the myometrial receptors, which are most sensitive to oxytocin, are activated more than others.

From the day the baby is born, the mother begins the countdown to the end of involution. Every day the uterus drops 1-1.4 centimeters, gradually it should return to its previous position in the pelvis. Return to the small pelvis is completed 10-11 days after birth.

The cervix closes smoothly, a day after birth it becomes smaller by 5 centimeters, but remains slightly open, which facilitates the release of lochia. The internal os of the cervix closes two weeks after birth, and the external os only after two months.

After the first birth, the closed external os no longer becomes round, but transverse, and this is the main difference between the cervix of a woman who has given birth and a woman who has not given birth. After the second or third birth, the shape of the pharynx is the same, only the process of involution proceeds a little slower due to the fact that the walls of the uterus and the muscles of the cervix are fairly stretched and less elastic.

Inside the uterus after childbirth there is a placental wound - the place where the placenta is attached. It is she who bleeds in the first days after childbirth and this is the main difference between lochia and menstruation. The wound tightens and heals by about 4 weeks after birth.

After a caesarean section, all processes are identical, but the situation is complicated by the presence of a scar on the body of the uterus.

Therefore, involution is somewhat delayed and can take up to 4-5 months.

The sensations that accompany involution normally resemble menstrual pain, but they are much stronger. Some women compare the sensation to the onset of contractions. But they are like this only in the first days; already a week after the birth of the child, the process of reverse development of the uterus will become almost imperceptible for the woman.

What influences?

Numerous factors influence the contractility of the uterus after childbirth: the number of births, the nature of the last birth, the woman’s age, as well as the possible development of postpartum complications. A particular influence is exerted by the hormone oxytocin, which is produced in exactly the amount necessary for the involution of the reproductive organ during breastfeeding. At the same time, nipple receptors are irritated, which send “signals” to the brain, and the production of prolactin and oxytocin is stimulated. If a woman is not breastfeeding, she should be given oxytocin. in injections.

Early breastfeeding and breastfeeding can speed up involution. In order for the uterus to shrink faster and return to its previous size, a fairly active motor mode is recommended without lifting heavy objects or excessive physical exertion.

If a woman lies down all the time, the contraction will proceed slowly.

Subinvolution

As you can easily guess from the presence of the prefix, the term means that involution proceeds pathologically, or, more precisely, not completely or partially. Among all postpartum complications, this situation occurs quite often: about 2% of postpartum women are faced with the fact that the uterus contracts poorly, for a long time, the contractions are painful, and the reproductive organ cannot achieve the required size.

Among other types of complications of the postpartum period, subinvolution has a record place - up to 50% of all complications are of this nature.

Since in most cases, poor contractility occurs against the background of an inflammatory disease - endometritis, scientists have not yet decided whether to consider subinvolution as a separate pathology or consider it only as a symptomatic sign of endometritis. The development of this condition is almost always associated with a violation of the contractility of the uterine tissue (myometrium).

But it can develop due to many individual factors and their combination. It is believed that tissue swelling after childbirth is affected, as well as slower formation of collagen fibers.

After a multiple pregnancy or pregnancy with a large baby, as well as if there have already been more than two births in the anamnesis, there is a risk of impaired contractility of muscle tissue due to its overstretching.

If an infection has entered the uterus at any stage of labor or before, then the likelihood of uterine subinvolution increases sharply, since the presence of infectious inflammation slows down the process of reducing natural early postpartum tissue edema.

Causes

In most cases, when asked why the uterus contracts poorly, obstetricians answer that it is an infection. This refers to the inflammatory process that is provoked by viruses or pathogenic bacteria that have entered the uterine cavity. Despite this, infection does not always cause weak contractility; sometimes endometriosis is diagnosed after childbirth as a separate disease, while the processes of involution in the postpartum woman are not impaired. Therefore, it was decided to derive not a list of causes of subinvolution, but a list of predisposing factors and circumstances that increase the likelihood of improper reverse development of the female reproductive organ after the birth process.

Such situations include the following factors.

Incomplete discharge of the placenta. Particles of the placenta and fragments of the membranes remained in the uterine cavity. After the birth of the placenta, obstetricians are required to make sure that the uterine cavity is cleaned, but this is done manually, that is, almost by touch. An inspection of the placenta is carried out on the obstetric table, checking the presence of all lobules and membranes at the “baby place”.

If there were ruptures of the placenta, then, like a puzzle, it is assembled piece by piece. This method allows you to avoid leaving large fragments, but no one is safe from leaving small ones.

Complications during pregnancy. This category of risk factors for subinvolution includes a large fetus (more than 4 kilograms at birth), polyhydramnios, multiple pregnancies, that is, factors that contribute to excessive stretching of the walls of the reproductive organ.

Exacerbation of cystitis and pyelonephritis during pregnancy, especially at the very end, is also considered an unfavorable factor, since these ailments increase the likelihood of infection entering the uterine cavity immediately after the birth of the baby.

Complicated childbirth. Subinvolution most often occurs in women who gave birth quickly, as well as in those whose labor was prolonged.
Body Features. It is believed that short women are more likely to suffer from uterine contraction disorders in the postpartum period than tall or average-sized women.

Genetic features. If a woman’s mother or grandmother suffered from subinvolution after childbirth, then the likelihood that the same will happen to their female descendants is very high.

Other unfavorable factors include the presence of uterine fibroids, the age of the postpartum woman under 19 years and after 35 years, the inability to breastfeed the child in the first days after birth, as well as various individual features of the structure of the uterus, for example, incorrect location of the reproductive organ, disruption of the functioning of its ligamentous apparatus .

Sometimes the uterus contracts poorly in postpartum women suffering from severe anemia, as well as those with chronic heart and vascular diseases.

Kinds

In obstetrics, there are several types of uterine contraction disorders in the postpartum period. Some exist mainly on the pages of obstetric textbooks and are found in isolated cases in real life.

True subinvolution- a rare pathology in which the uterus contracts poorly or does not contract at all for no apparent reason (there is no inflammation, no infection, no parts of the placenta in it). This group includes a myogenic disorder, in which the lack of involution is associated with impaired muscle elasticity, a myocirculatory disorder, in which tissue swelling slowly decreases and the circulatory network of the reproductive organ is less restored, as well as an endocrine disorder, in which the production of natural oxytocin in the female body is insufficient.
Infectious subinvolution- a very common phenomenon in which the contractility of the reproductive organ is impaired due to a bacterial or viral inflammatory process in the uterine cavity.

Symptoms and signs

The discharge of lochia after childbirth is normal, but normally on the fifth day they become smaller, and the nature of the discharge changes to mucous. Subinvolution is indicated by the persistence of bright and fairly abundant lochia of a brownish color for several weeks.

Also, indirectly, a violation of uterine contractions may be indicated by the absence of painful spasms in the lower abdomen while feeding the baby with breast milk.

Some women report unpleasant nagging pain almost constantly, although it does not depend in any way on the breastfeeding regimen.

If the disorder is infectious in nature (which is most likely, given the prevalence of just such subinvolution), then the symptoms will fully correspond to the symptoms and signs of endometritis. A high temperature rises and a feeling of chills appears. If at the same time the lochia cease to be bloody and become greenish or yellow with an unpleasant odor, they speak of purulent endometritis.

Touching the abdomen and the doctor’s attempts to palpate it through the anterior abdominal wall cause pain in the postpartum mother; as inflammation develops, headaches and weakness intensify, nausea and heart rhythm disturbances may occur.

Diagnostics

Violation of uterine contraction at the current level of development of diagnostic medicine is usually not only easily determined, but also predicted. Even during pregnancy, among all expectant mothers, obstetricians and gynecologists identify women who have an increased risk of such consequences. These include expectant mothers of very short stature, and multiparous women, and those who are carrying twins or triplets, as well as those carrying large babies, suffering from polyhydramnios and gestosis in late pregnancy. They are closely monitored not only during gestation, but also in the very early postpartum period.

After the birth of the baby, a consultation with an obstetrician can determine if a woman has contraction disorders of the reproductive organ. The doctor identifies the duration, nature and volume of postpartum discharge, evaluates other symptoms characteristic of subinvolution.

To clarify and confirm the diagnosis, a gynecological examination is performed. The chair reveals an unacceptable size of the uterus after birth and its irregular shape. The cervical canal of the cervix is slightly open, there may be an accumulation of blood clots in it, the cervix has a purple or purple color, it is swollen. Ultrasound shows the exact size of the uterus, as well as the thickening of its walls. If there is something foreign in the cavity of the reproductive organ, this is also confirmed by ultrasound examination with great accuracy.

Hysteroscopy can also come to the aid of doctors. This study provides accurate answers to all questions; in addition, it is possible to take a tissue sample from the inner surface of the reproductive organ for analysis, which allows you to accurately determine the type of infectious agent. The woman undergoes a urine and blood test, and a vaginal smear is taken for microflora.

In severe cases, an MRI of the pelvic organs may be prescribed.

Treatment

Violation of uterine contractions after the birth of a baby necessarily requires treatment. Whatever the original cause of the disorder, sooner or later, if left untreated, it becomes infectious, and full-fledged endometritis or endomyometritis develops. If such conditions are not treated, then the development of sepsis, peritonitis, septic shock, and severe uterine bleeding is possible. Previously, these complications were a fairly common cause of death after childbirth. Now there is every opportunity not to bring the problem to mortal danger and serious consequences; for this you need to start treatment on time.

You can help a woman in a comprehensive way. Treatment consists of the use of medications, instrumental therapy and massage. If a bacterial infection is detected, they begin to fight it first: the woman is prescribed antibiotics in tablets, in injections - how exactly, the doctor decides based on the severity of the inflammatory process.

It is difficult to say how long the treatment will last; in each case, the general state of the mother’s immunity and the peculiarities of the course of her pathology play a role.

For treatment, hormonal drugs based on oxytocin are used - “Oxytocin”, “Methylergometrine”, etc. They improve the contractility of uterine tissue. If fragments of the placenta or fetal membranes are found in the uterine cavity, or if there is an accumulation of blood clots in it that have blocked the cervical canal, all foreign objects are removed from the cavity of the reproductive organ. This occurs under anesthesia using vacuum aspiration or curettage (curettage) using obstetric instruments. This ultimately allows the uterus to contract completely.

Painkillers are used to relieve pain, to relax the cervix when clots accumulate, “No-shpu” and other antispasmodics are used in combination with hormonal drugs to enhance the contractility of the myometrium.

Treatment most often takes place in a hospital, where it is possible to constantly monitor the dynamics, do tests and, if necessary, supplement or replace medications in the treatment regimen, administer drugs in the form of a dropper. Gynecological massage has proven itself well in the treatment of uterine subinvolution, which can improve the condition of the myometrium and speed up recovery after childbirth.

Bed rest is indicated. A woman should not exert much effort, experience physical activity, or stress.

After the acute period of inflammation is left behind, physiotherapy sessions and therapeutic exercises are recommended.

Doctors' prognoses when uterine subinvolution is detected after the birth process are usually positive and favorable, since the pathology is highly treatable. And this is a reason to stop worrying and being nervous because the doctor believes that the uterus is contracting worse than necessary. The situation is unpleasant, but not critical.

To prevent problems with uterine contractions Women at risk are recommended to administer oxytocin in the first hours and days after childbirth in injections, regardless of whether they have symptoms of mild involution or not.

Folk remedies

It should be understood that in this case it is impossible to replace traditional treatment with folk remedies.

In addition, you should not prescribe folk remedies yourself, because they can affect the quality of breast milk and the well-being of the baby.

At home, alternative medicine recipes can help improve the recovery of the uterus after the acute period of inflammation is left behind. There are pharmaceutical herbal preparations based on arnica flowers, nettle leaves and roots, from which you can prepare an aqueous tincture for oral use.

Other herbs that help cleanse the uterine cavity include yarrow, shepherd's purse, and horsetail. In addition to drinking, these herbal remedies are used to make baths for washing.