a. Causes. Endometritis, retained placental fragments, pelvic infection, and
uterine fibroids may cause uterine subinvolution.
b. Signs and Symptoms.
Prolonged lochial flow.
Large, flabby uterus.
c. Medical Treatment.
(1) Administration of oxytocic medication to improve uterine muscle tone.
(a) Methergine -a drug of choice since it can be given by mouth.
(b) Pitocin .
Dilation and curettage (D&C) to remove any placental fragments.
Antimicrobial therapy for endometritis.
d. Nursing Interventions.
Early ambulation postpartum.
Daily evaluation of fundal height to document involution.
6-15. PUERPERAL INFECTION
Puerperal infection is a term used to describe any infection of the reproductive
tract during the first six weeks of postpartum.
a. Pathology. When the third stage of labor is completed, the placental
attachment site is raw, elevated, and dark red. The surface is nodular, owing to the
numerous veins, and offers an excellent portal of entry for microorganisms. The uterine
decidua is very thin and has many small openings that offer a portal for pathogens. In
addition, small cervical, vaginal and perineal lacerations, as well as the episiotomy site,
provide entry ports for pathogens. The resultant inflammation and infection can remain
localized or can extend via blood or lymph vessels to other tissues.