Also known as
The failure of the uterus to contract maximally after the delivery of the baby and placenta, resulting in heavy uterine bleeding.
Description
# Uterine atony is the most common cause of postpartum hemorrhage and the most common indication for postpartum hysterectomy or blood transfusion.
# Normally, bleeding after delivery is stopped by uterine contractions and compression of the vessels. If uterine contractions are not adequate, bleeding can continue. At times, the uterus is prevented from contracting effectively by fragments of placenta that remain in the uterus after delivery or by benign growths of uterine muscle within the uterine wall (fibroids). In these cases, the term 'atony' usually is not applied. In most cases, the uterine muscle simply fails to contract adequately.
Causes
# Multiple gestation, high parity
# Fetal macrosomia
# Polyhydramnios
# General anesthetics
# Prolonged labor, precipitous labor, augmented labor
# Infection (chorioamnionitis)
Symptoms
# Excessive bleeding at the time of delivery
Diagnosis
# The presenting signs are a soft uterus with vaginal bleeding.
# After delivery, uterine atony is detected when there is excessive bleeding and a large, relaxed uterus. Your doctor may perform an examination to be certain that there are no tears of the cervix or the vagina and that all fragments of placenta have been removed from the uterus.
# Alternate sources of bleeding, such as vaginal or cervical lacerations or retained placental fragments, must be excluded.
Treatment
# Initial treatment consists of bimanual compression, uterine massage.
# Uterine contraction medications: Oxytocin, Methylergonovine, and Prostaglandins
# Surgery: uterine vessel ligation or hysterectomy (the latter is rarely used)
# Blood and fluids must be replaced as needed.
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