METRITIS (SUBINVOLUTION OF THE UTERITS).—Since metritis and endometritis in the septic sense nearly always co-exist in the same case the reader is referred to the article OD ENDO METRITIS. Inflammation of the uterus or appendages occurring after labor inter feres with normal involution, and gives rise to a series of changes called puerperal subinvolution. Irritation or inflamma tion existing at the time of menstruation interferes with the subsidence of the menstrual development, and causes a per sistent enlargement. which has been called menstrual subinrolution.
Puerperal S11 bi volu tion Symptoms and Diagnosis.—In cases observed within the first \veel: or two after labor or abortion there may he the symptoms of acute endometritis, and in fection of the pelvic viscera may appear. These have been reviewed under Ect,A31P STA.
In others there may be no symptoms ' float attract attention until the patient 1 aN is the bed, or begins to use the vessel fk.q. a past:age of urine or freees, \Own s'rie may be taken with uterine rliage and perhaps with uterine cramps and faintness. There is usually a slight t ion of temperature and some supra pubic tenderness. An examination re ea.s an enlarged, tender uterus with a patulous os. In cases occurring after labor, or after abortion during the latter half of pregnancy. the finger easily passes the internal os and discovers masses or shreds of adherent placenta. That t:on of the uterine wall to which these are attached is usually relaxed, and may 1 ulge into a generally relaxed uterine cavity, or may be surrounded by an ir regularly-contracted uterus.
If the placental site is at or near the fundus, a contracted ring may have formed just below it.
In other cases the patient will get up with more or less backache and feelings of weight and pressure in the pelvis, and with some leucorrhcea. The menses will usually become established early, and will , he abundant or even profuse.
In acute metritis the pain is deep seated and diffuse, and radiates toward the loins, hips, and hypogastrium. It is principally intrapelvie, and is accom panied by resical and rectal tenesmus.
Doleris and Pichevin Gynec., No. 6, '06).
An examination reveals a large, soft uterus lying low in the pelvis. The cer vix is soft and purplish, and the vagina and perineum relaxed and somewhat deeper in color than natural. In occa sional eases a piece of placenta is passed several weeks after labor or abortion.
As the condition becomes more chronic. the uterus remains enlarged, but ,grows. hard. while the cervix assumes a pale, anwmic appearance. Or the cer vix may show the signs of laceration, erosion, and ectropion. The later symp toms are those of chronic endoinetritis. The inenorrhagia may persist, or it may filially grow less and be followed by nor mal or even by scanty menstruation.
inflammation or trau matic injury within the pelvis may act as a cause. Retained particles of pla centa, laceration of the cervix, and in fection are the most common ones.
Retroversion of the uterus, pelvic tumors, getting up too soon, and frequent coitus may also delay or prevent complete involution.
Pathology.—In puerperal subinvolu tion the uterine muscular fibres and take on atrophic changes much slower than normal. The muscu lar fibres are longer than natural and re laxed; the blood-vessels are enlarged and surrounded by a serous infiltrate. The walls are purplish in color and soft, are easily injured, and, if injured, bleed freely. This condition may continue for many months.
As a rule, there is a focus of inflamma tion at the placental site or about a cervi cal laceration, which causes the ordinary changes of inflammation to extend to a greater or less distance into the paren chyma.
After a time embryonic cells appear between the muscular fibres and about the blood-vessels, and, as they- mature, diminish the caliber of the blood-vessels and displace and cause atrophy of the uterine muscular fibres. Thus in time the walls become pale and anmnic, and the connective tissue predominates over the muscular, giving- the structure a hard, fibrous character.