  Subinvolution of the uterus is a condition that results from imperfect involution of the uterus after labor, abortion, or miscarriage. The muscular and fibrous structures of the uterus, which had become hypertrophied under the influence of pregnancy, fail to undergo properly the retrograde changes of fatty degeneration and absorption which normally occur after the expulsion of the product of conception, and which are essential for the restoration of the uterus to its normal size. The elements of the endometrium and the vascular system of the uterus also remain hypertrophied; consequently the uterus is larger, heavier, more congested than normal. Similar arrest of involution may occur coincidently in the ligaments of the uterus, which are left larger, longer, and more relaxed than in the normal condition. The pathological changes that occur in the subinvoluted uterus are similar to those found in chronic endometritis and metritis, which have already been described. In fact, chronic endometritis and metritis accompany subinvolution from the beginning. There are many causes of subinvolution of the uterus. Too early rising from bed is a most frequent cause. This is especially true after abortion or miscarriage; for many women treat such occurrences as of but little moment, and refuse to stay in bed for more than a few days. Imperfect evacuation of the uterus after abortion or miscarriage is a common cause. Laceration of the cervix, The symptoms of subinvolution are the same as those already described under Chronic Metritis—backache, headache, bearing-down pain in the pelvis, general physical debility, leucorrhea, and menorrhagia. The treatment of subinvolution should be directed toward the relief of the primary cause of the condition. Laceration of the perineum or of the cervix, retroversion, or endometritis caused by retention of placental tissue after miscarriage, should receive appropriate treatment. Subinvolution may often be cured by the douches, iodine applications, and depletion of the cervix spoken of under the treatment of laceration of the cervix, provided the primary cause is removed or corrected. In any case the cure is always hastened by thorough curetting of the uterus. This operation should always be performed when the woman is etherized for the relief of any other condition, as a laceration of the cervix or of the perineum. The cure of subinvolution depends a great deal upon the time that has elapsed from the inception of the condition to the institution of treatment. The secondary changes in the endometrium and body of the uterus resulting from chronic congestion and inflammation in time becomes so established that the disease will not yield to any treatment, even though the primary cause of the trouble may be cured. In obstinate chronic cases of subinvolution of the uterus amputation of the cervix sometimes has a most marked effect, and this operation should always be resorted to whenever the disease has resisted the milder treatment already prescribed. Amputation of the cervix is sometimes followed by a transformation of all the tissues of the uterus similar to that occurring in normal involution after labor, and a striking diminution in the size of the uterine body takes place. The amputation of the cervix should always be accompanied by a thorough SUPERINVOLUTION OF THE UTERUS.Superinvolution of the uterus is a disease the reverse of subinvolution. In this condition the uterus, after childbirth or abortion, not only undergoes the normal involution, but continues to atrophy until the length of the uterine cavity may measure but one and a half inches. The atrophy involves the neck as well as the body of the organ, the Fallopian tubes, and sometimes the ovaries. Superinvolution of the uterus is a rare condition. The cause is difficult to determine. It has been attributed to great loss of blood at confinement, to prolonged lactation, and to pelvic peritonitis occurring during the puerperium. Amenorrhea is the most marked symptom of superinvolution. Nervous disturbances and hysterical symptoms may also be present. The diagnosis is easily made from the history of the case and by means of bimanual examination and the use of the sound. Congenital malformation may be excluded from the fact that a pregnancy has occurred, and senile atrophy from a consideration of the age and history of the woman. The treatment should be directed to restoring and maintaining the general health of the woman. Iron and the remedies useful in other forms of amenorrhea may be of advantage. |
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