How does the uterus contract normally?
Immediately after birth, the fundus of the uterus is approximately at the level of the navel, and its weight is about a kilogram. Then every day it drops by about one to two centimeters and by the end of the first week it can be felt at the symphysis pubis, and after six weeks it returns almost to its original size. At the same time, the discharge changes: bloody in the first days, bloody by the end of the first week and light mucous by the third or fourth week. Contraction is ensured by muscle fibers and the hormone oxytocin, the production of which is stimulated by the baby's attachment to the breast.
- Daily decrease in fundal height of the uterus
- Changing the nature of discharge by week
- The role of oxytocin and breastfeeding
- Full size restoration in 6 weeks
- Slower recovery after cesarean section
Causes of slow contraction
Most often, mechanical obstacles interfere: placental tissue remaining in the cavity, membranes, large blood clots. The second big reason is inflammation of the uterine mucosa, in which the muscle contracts worse. Overstretching of the uterus during childbirth with multiple pregnancies, a large child and polyhydramnios, as well as prolonged or, conversely, rapid labor, also has an impact. Less commonly, the cause is fibroids, a scar after a cesarean section, a bend of the uterus, a full bladder and immobility of the postpartum mother. Not breastfeeding also slows down the process due to less oxytocin production.
- Remains of placental tissue and membranes
- Blood clots in the uterine cavity
- Postpartum mucosal inflammation
- Overstretching of the uterus during childbirth
- Caesarean section and uterine scar
- Uterine fibroids
- Full bladder and lack of mobility
- Lack of breastfeeding
Symptoms
The main symptom is prolonged bleeding that does not clear up as expected and sometimes intensifies. The woman notes a nagging pain or heaviness in the lower abdomen, weak postpartum contractions or their absence. Upon examination, the doctor determines that the uterus is larger than expected on the day after birth, has a soft consistency, is painless with an uncomplicated course. If inflammation occurs, fever, chills, unpleasant odor of discharge, and soreness of the uterus appear. Prolonged blood loss leads to anemia with weakness, dizziness and rapid heartbeat.
- Prolonged bleeding
- Increasing discharge instead of decreasing it
- Nagging pain and heaviness in the lower abdomen
- The uterus is larger than normal for a given day
- Weak postpartum contractions
- Temperature and odor of discharge during inflammation
- Weakness and dizziness due to anemia
Survey
The doctor assesses the height of the uterine fundus, its consistency and soreness, examines the cervix and the nature of the discharge. The main tool is an ultrasound examination: it shows the size of the uterus, the width of the cavity, the presence of contents, clots and tissue debris, as well as the condition of the scar after cesarean section. A complete blood count helps identify inflammation and anemia. A smear is taken and culture, if necessary. If there is a suspicion of remnants of placental tissue based on ultrasound, hysteroscopy becomes the optimal method for clarification and at the same time treatment.
- Inspection and determination of the height of the uterine fundus
- Ultrasound of the uterus with assessment of the cavity and contents
- Complete blood count and C-reactive protein
- Smear and culture from the cervical canal
- Assessment of scar condition after cesarean section
- Hysteroscopy if tissue remains are suspected
- Hemoglobin and ferritin control
Treatment and prevention
If the uterine cavity is free, contracting drugs are prescribed, it is recommended to empty the bladder, lie on your stomach, move more and continue breastfeeding - all this strengthens contractions. If remnants of placental tissue or large clots are detected, they are removed, preferably under hysteroscopy control rather than blindly. If there are signs of inflammation, antibiotics are added. Anemia must be treated with iron supplements. Prevention begins in the maternity hospital: early breastfeeding, early activation, regular bladder emptying and control of uterine contractions.
- Drugs that contract the uterus as prescribed by a doctor
- Emptying your bladder regularly
- Early physical activity, prone position
- Continued breastfeeding
- Removing tissue debris and clots
- Antibacterial therapy for inflammation
- Treatment of anemia with iron supplements
- Control ultrasound after treatment
