Subinvolution medication?

Explanation

Core Concept: Subinvolution is the failure of the uterus to return to its normal non-pregnant size and state, often caused by retained placental fragments or pelvic infection. Methylergonovine (Methergine) is an ergot alkaloid that stimulates sustained uterine contractions to control bleeding and promote involution.

Clinical Presentation:

• Prolonged or excessive lochia, a boggy or enlarged uterus, pelvic pain, and abnormal uterine bleeding.

Diagnosis:

• First-line plan: Bimanual pelvic examination to assess uterine size and tone.
• Gold standard: Transvaginal or pelvic ultrasound to identify retained products of conception (RPOC).

Management:

• Acute: Administer uterotonic agents (Methergine or oxytocin) to contract the uterus. Contraindicated in patients with hypertension.
• Long-term/Definitive: Dilation and curettage (D&C) if retained tissue is confirmed, antibiotics if endometritis is present, and close postpartum follow-up.