2016 Volume 30 Issue 2 Pages 333-341
Purpose
The purpose of this study was to elucidate the chronological changes that take place during involution of the uterus after Caesarian section (CS) to obtain basic data for use in the assessment of an involution state.
Methods
The participants were 70 women who underwent CS of a single, full-term fetus and experienced a normal postoperative course thereafter. Fundal length and height of the uterus were measured from puerperium day 0 to puerperium day 7. Forty-eight of the 70 women were included in color analysis of the lochia using a self-administered questionnaire to record daily changes in lochia color. Statistical analysis was performed using SPSS ver. 22.0 software, and P < 0.05 was considered statistically significant.
Results
Mean fundal length gradually decreased from 18.1±0.32 (mean±SE) cm on puerperium day 0 to 15.6±0.21cm on puerperium day 3 and 13.4±0.20cm on puerperium day 7. Mean length decreased approximately 1 cm per day on puerperium days 1 and 2 (p < 0.01) and an additional 1 cm on puerperium day 4 and puerperium day 6 (p < 0.01). Median fundal height was one finger-width below the navel on puerperium day 0, two finger-widths on puerperium day 3, and three finger-widths on puerperium day 6, although there was wide variation in the measurements.
Lochia color, as checked by the puerperal women, showed significant change starting on puerperium day 6 (p < 0.05); however, 30% of the puerperal women still had red-colored lochia.
Conclusion
Post-CS fundal length was longer and showed more marked changes in comparison to vaginal births. Our investigation of changes in fundal height, as determined via palpation, indicated that three days were required for the height to decrease by one finger-width below the navel and that there was wide variation in the data. Notably, assessments dependent upon palpation are particularly susceptible to individual interpretation. In comparison to vaginal births, in CS births, lochia color change and involution of the uterus take longer to occur and the uterus is softer.
The results of this study, wherein satisfactory postpartum progress was observed after normal, standard CS of single full-term fetuses, represented basic data related to early puerperium involution of the uterus following CS; these data can be utilized as assessment criteria in the future.
