What are common causes of subinvolution during the puerperium?

Subinvolution of the uterus refers to the failure of the uterus to return to its normal size and condition after childbirth, which can lead to complications such as prolonged bleeding and infection. A primary cause of subinvolution is retained placental fragments. When portions of the placenta remain in the uterus after delivery, they can prevent the uterus from contracting effectively, which is necessary for it to shrink properly. The presence of these fragments can stimulate further bleeding and inhibit the normal healing process, making it critical for healthcare providers to monitor for and manage this condition.

Other factors, while they may have their own implications during the postpartum period, do not directly contribute to subinvolution in the same way retained placental fragments do. For instance, excessive exercise and stress can impact overall recovery, but they do not have the same direct physiological effect on uterine involution. Similarly, hemorrhoids, while a common issue during and after pregnancy, are related to vascular changes and often do not affect the involution of the uterus itself. Understanding the importance of monitoring for retained placental fragments can help ensure appropriate postpartum care and recovery.