Uterine revolution is a process where the uterus returns to its pre-pregnancy condition and weighs (about 60 grams). This process begins immediately after the placenta is born due to contraction of the smooth muscles of the uterus. The intensity of uterine contractions increases in response to a very large decrease in intrauterine volume.
Postpartum hemostasis is achieved mainly due to compression of intramiometrial blood vessels. The hormone released by the pituitary gland strengthens, regulates uterine contractions, compresses blood vessels and helps hemostasis. For 1 to 2 hours after the partum, the intensity of uterine contractions can be reduced and become gradually irregular. The importance of maintaining uterine contractions during this time, the mother is encouraged to breastfeed her baby. Early Initiation of Breastfeeding is the consciously baby starts breastfeeding himself after birth. The initiation of breastfeeding and suction of breast nipples by the baby is the normal indication of the puerperium period strengthening the stimulation of oxytocin release. When the baby sucks the nipple, the nerve reflex stimulates the posterior lobe of the pituitary gland to secrete the oxytocin hormone. Here, oxytocin accelerates the process of involution and minimizes blood loss.
The process of uterine involution
Here are brief explanations on how the uterine starts its involution to its normal condition.
- Ischemia in the myometrium is also called local ischemia
- There is a lack of blood in the uterus. This blood deficiency is not only due to long contractions and retractions but also is caused by a reduction in blood flow to the uterus during pregnancy. This occurs because the uterus must enlarge to adjust to fetal growth.
- To meet their needs, large amounts of blood flow into the uterus can cause hypertrophy and hyperplasia. After the baby is born, this is no longer needed, then the blood flow decreases again as usual. Blood flow has flowed to the breast so, blood circulation to the breast becomes normal and better.
- The uterus will experience a lack of blood. As a result, the muscles of the uterus experience otropy back to its original size.
Shrinkage will reach its original state when the destruction of the uterine muscle tissue (grows due to hyperplasia).
Also, enlarged muscle tissue becomes 10 times longer or becomes 5 times thicker than during pregnancy. Factors causing autolysis between hormones or enzymes are still unclearly known. Another theory said it has been known that the destruction of protoplasm and tissue absorbed by the blood. That is later excreted by the kidneys. This is why a few days after giving birth, the mother experiences frequent urination.
The factors of uterine involution
The process of involution can occur quickly even slowly. Here are factors that affect uterine involution include:
- Early mobilization
Muscle activity contractions and retractions of the muscles after the baby is born, needed to clamp the broken blood vessels. This is needed due to the release of the placenta. Also, it is useful for removing uterine not needed contents, with continuous contractions and retractions causing disruption of blood circulation in the uterus. It results in muscle tissue deficiency – the substances needed, so the size of the muscle tissue becomes small.
- Nutritional status
Nutritional status is the level of a person’s nutritional adequacy related to gender and age. Worse nutritional status in postpartum mothers is also useful for removing nephrotic tissue. In postpartum, mothers with good nutritional status will be able to avoid attacks germs so there is no infection during the puerperium. Further, it can accelerate the process of uterine involution.
In the breastfeeding process, there is a letdown reflex of the baby suction posterior pituitary stimulating to expel the hormone oxytocin. Later lifted to the uterus by the blood and helps the uterus contract so that the process of uterine involution occurs.
The aging process increases the amount of fat. Since, it influences decreased muscle elasticity, absorption of fat, protein, and carbohydrates. If this process is associated with a decrease in protein in the aging process, this will inhibit uterine involution.
Parity affects the uterine involution. Regarding, muscles that are too often stretched take a long time.
Measurement of uterine involution
Measurement of uterine involution can be done by measuring the fundus uterine height, uterine contractions also removing the locka. Uterine revolution involves reorganization and dating of the decidua and exfoliation of the skin on the placental site. This is usually used as a sign of decreased size and weight, changes in uterine location, color and number of lockheas.
The uterine revolution is a medical condition after giving birth. If the uterus does not return to its normal size, we can say that the process of reducing the uterus is blocked.
Here are several predisposing factors
- Excessive stretching of the uterus as in twin pregnancies and hydramnios
- Maternal health problems
- Cesarean section
- uterine prolapse
- Retroversion (deformity) after the uterus returns to being a pelvic organ
- Uterine fibroids
Pathophysiology of uterine subinvolution
This is caused by the lack of blood in the uterus. Blood deficiency is not only due to long-term contractions and retractions, but also is caused by a reduction in blood flow going to the uterus in the stomach of pregnant women. Since in this condition, the uterus must enlarge to adjust to fetal growth. To meet their needs, a lot of blood flows into the uterus. This blood can carry out hypertrophy and hyperplasia, then blood flow decreases returns to normal. Thus, with the existence of these things, the uterus will experience a lack of blood so that the uterine muscle tissue experiences atrophy returns to its original size. The uterine subinvolution causes decreased uterine contractions. Then, the wide blood vessels do not close perfectly, so that bleeding occurs continuously. It can cause other problems both infection or inflammation in the uterus, especially endometrium. the involution process that should occur after the puerperium is disrupted due to the results of the above problems.
Clinical manifestations of Uterine Subinvolution
Usually, subinvolution signs and symptoms do not appear, it will naturally seem until about 4-6 weeks postpartum.
- The uterine fundus is located high in the abdomen or pelvis from the expected or decreased slow uterine fundus and soft uterine tone.
- The output of chochia often fails to change from the form of rubra to serous form, later it forms chochia alba.
- Lochia can remain in the form of rubra within a few days postpartum or more than 2 weeks postpartum
- Lochia can be more than expected
- Leukore and lochia are smelly, they can occur if there is an infection
- Pale, dizzy, and low blood pressure
- There can be a large amount of postpartum bleeding (> 500 ml)
- The pulse is weak, restless, tired, cold extremity