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What Dose Sub Involution Of Uterus Indicate In My Anteverted Uterus Transabdominal Sonogram?

Posted on Mon, 30 Mar 2015

Question: Dr Vjollce Mbiarra: Hello again Hope you can help Sonogram during D/C showed anteverted uterus transabdominal sonogram showed products of conception and "tssue" being removed by suction. Later a pathology report allegedly showed no products of conception and described a "sub involution of uterus" Question : should original sonogram showed "sub involution of uterus" and "anterverted uterus" and was "tissue" seen being removed products of conception. thank you

Answered by Dr. Vjollce Mbiarra (7 hours later)

Brief Answer:
Yes it is possible

Detailed Answer:
Hi dear again and thanks for trusting to us.

First let me explain to you some definition:

Involution of uterus is -the process by which the uterus attempts to return to its pre-pregnancy size and condition , this process last from 4 to 6 weeks.

Suinvolution-is when the process of involution haven't occur yet

Anteverted uterus-the uterus leans forwards over the top of the bladder,and this is the most common position of normal uterus.

Hence both of these terms can be shown in a sonogram report,as the remnant tissue was there and than is removed by suction.

Subinvolution of uterus have occur while has been the remnant product of conception.

While the remnant product of conception is removed ,be calm because the process of involution will be fast.

Best regards form DR.Vjollce

Above answer was peer-reviewed by : Dr. Pradeep Vitta

Follow up: Dr. Vjollce Mbiarra (2 hours later)

Thanks again hope you are well In this case female 12 days since birth began heavy bleeding and clotting. D/C performed as above. Sonogram during procedure showed products of conception. Tissue sent for pathology. Was told report showed no products of repro but bleeding casuse by sub involution. Can this be correct ? Was told may not

Answered by Dr. Vjollce Mbiarra (1 hour later)

Brief Answer:
It may be correct

Detailed Answer:
Hi again!

Subinvolution of uterus cause subinvolution of placental site or uterine vessels fail to involute following delivery,causing excess bleeding,as that female .

The main causes of subinvlution are
1.RPOC(this is excluded by histopathology)
2.Infection or endometritis( patient have high temperature,abdominal pain and excess bleeding )
3.Idiopathic cause(more chances in your case)

Sonogram can over-diagnose a RPOC ,hence histopathology make correct diagnose.

As my opinion if she have more bleeding and her Hb(hemoglobin) and hematocrit levels are low ,she should start to treat with:
1.Uterotonic agents like ergometrine
2.Antibiotics therapy with broad spectrum like Augumentin
3.Infusions

Best regards

Above answer was peer-reviewed by : Dr. Pradeep Vitta

Follow up: Dr. Vjollce Mbiarra (27 minutes later)

Really appreciate your consideration of issue. One final inquiry: D/C as above performed on july 12. Female continued to bleed subsequent D/C on July 31 again found products. Would this mean pathology report of july D/C attributing bleeding to sub involution INCORRECT thanks again

Answered by Dr. Vjollce Mbiarra (1 hour later)

Brief Answer:
detailed below

Detailed Answer:
Hi dear again.

Please tell me the histopathologic diagnose was in the first D&C or on the second one?
As I said above the gold method to determine that the cause of involution of uterus is from RPOC or not is histopathologic method.
Hence if they have done histopathology of product and it was negative per RPOC,it doesn't mean that postpartum bleeding isn't from subinvolution of uterus,because it has many other reason other than RPOC.

Fining again product in her uterus doesn't mean that it should be only RPOC,it may be only clotted blood .

I hope I would explain .

Best regards

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Vjollce Mbiarra (1 hour later)

I hope not taking up too much of your time and I thank you In short July 12 D/C (First one)products were visualized on sonogram and removed. Pathology report of first indicated no products but bleeding caused by sub involution. Bleeding continued Second D/C July 31 removed products. Is pathology report on First D/C incorrect based on finding products after second D/C July 31

Answered by Dr. Vjollce Mbiarra (17 hours later)

Brief Answer:
There are tow chances

Detailed Answer:
Hi again ,and don't worry for my time because is my pleasure.

Since D & C is repeated for the second time although histopathological diagnosis was negative,and is found product, then there are two possibilities:
1. Histopathological diagnose is incorrect
2. During the procedure of D & C has not been taken of the remaining product.

Best regards

Above answer was peer-reviewed by : Dr. Pradeep Vitta