Uterine atony is a life-threatening medical issue that can develop following childbirth.
It happens due to the incomplete contraction of the uterus after the baby is born and consequently postpartum hemorrhage ensues which can be fatal.
Contractions of the uterus are the usual way that shows to deliver placenta following childbirth and blood vessels connected to the placenta are compressed by these contractions leading to decreased bleeding.
In case of uterine atony, the uterine muscles may not contract hard enough to stop the blood vessels from bleeding resulting in hemorrhage.
Epidemiology
At least 75% of postpartum hemorrhage cases and 1 in 40 complicated births in the US are caused by the uterus not contracting effectively after delivery.
Seventy to eighty percent of PPH cases are caused by uterine atony.
Anatomy
Pathophysiology
One of the causes of uterine atony can be explained by poor muscle tone, which is the condition occurred because of the breakdown of regular muscular contractions.
Other reasons for having uterine atony includes stretching of the uterus, which usually occurs in cases of multiple gestations and large infants, is a key factor that instigates uterine atony.
Long strenuous pains may eventually make the uterus muscles weak.
Retained placental fragments are a common cause.
The uterus that is under infection usually gets in a shift in muscle function as well as failure to release or respond to oxytocin in a normal way.
Etiology
Instances of uterine atony may occur due to prolonged or preterm labor, hypertensive disorders in pregnancy, uterine distension.
Premature fluid breakage or typical presentation of the fetus inside the womb, magnesium toxicity and increased doses of oxytocin may be the associated factors.
Improper uterine contraction may be the cause of increased levels of fibrin degradation products, uterine inversion among others.
Also, obesity that is represented by a BMI of above 40 is another high-risk factor for postpartum uterine atony.
Genetics
Prognostic Factors
The recurrence risk may be as high as 15%, compared to the preceding pregnancy cases for women who are previously diagnosed with PPH.
Class III obesity is associated with highest probability of causing a second episode.
The risk of recurrence is partially dependent on the underlying cause.
Clinical History
Recent labor or childbirth and existence of risk factors like uterine atony in prior pregnancies, large baby, extended labor, multiple pregnancies, etc may be included under clinical history.
Physical Examination
Uterine Palpation: Following delivery, the uterus may feel swollen and enlarged rather than firm and contracted, as would be expected.
Heavy vaginal bleeding can be observed which might lead to hypovolemia, dro in blood pressure etc.
Examination of the abdomen: Examining for bruises or distention in the abdomen along with size of the uterus, consistency, and tenderness as evaluated by palpation.
Examination of the pelvis: Visual examination for hematomas or perineal cuts should be carried out.
Ultrasound evaluation can be carried out to check for the presence of placental fragments, any retained products, and atony signs.
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Differential Diagnoses
Ruptured uterus
Coagulopathy
Inversion of the Uterus
Uterine subinvolution
Vascular deformities
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
The aim of the treatment approach consists of individual steps that help to stabilize the patient, stopping hemorrhage and restoration of the uterine tone.
Depending on the severity of the ailment and the outcome of early interventions, this paradigm might change.
by Stage
by Modality
Chemotherapy
Radiation Therapy
Surgical Interventions
Hormone Therapy
Immunotherapy
Hyperthermia
Photodynamic Therapy
Stem Cell Transplant
Targeted Therapy
Palliative Care
modification-of-environment
Ensure that well-defined procedures are available in hospitals for handling obstetric emergencies, such as uterine abortion.
Uterotonic drugs should be readily available.
Proper training regarding uterine massage should be given to healthcare professionals.
Administration of pharmaceutical agents with drugs
Use of uterotonic agents
Oxytocin:
Oxytocin is the primary treatment for uterine atony during cesarean delivery.
It is recommended to be administered immediately after delivery to prevent uterine atony and manage postpartum hemorrhage.
However, the optimal intravenous infusion dose remains controversial and a universal dose is not suitable.
It targets the smooth muscle of the uterus enhancing rhythmic contractions by binding to the dopamine D1 receptor which resulting in a rapid tetanic uterotonic effect, shortening the third stage of labor and reducing blood loss.
Carboprost:
It treats postpartum uterine hemorrhage due to atony and particularly reduces bleeding.
This drug reduces blood loss during surgeries and also in few conditions that involved increased bleeding.
It significantly decreases the mortality and reduce the need for laparotomy in uterine atony.
It is recommended as an adjunct to standard uterotonics by enhancing hemostasis and reducing blood loss without increasing risks to the mother or fetus.
surgical-intervention
If medications fail and excessive bleeding persists then surgical management is necessary.
Techniques include urinary packing which involves tightly packing the uterus with gauze and inserting a Foley catheter for bladder drainage, and the Bakri balloon which inserts a balloon for bladder drainage.
Surgical management techniques include urinary curettage, uterine artery ligation, compression sutures (B-Lynch), gynecologic oncologist hypogastric artery ligation, and a hysterectomy when other methods fail to control bleeding.
These techniques are efficient and quickly implemented by using rolled gauze ribbons.
phases-of-management
The phases of management includes:
Initial prevention
Medical intervention
Tamponade techniques and surgery
If atony occurs despite preventive measures and medical management is necessary by using techniques like oxytocin, methergine, prostaglandins, ergot alkaloids, and misoprostol.
If bleeding persists tamponade techniques are used to apply pressure and stop the bleeding.
If conservative methods fails and surgical intervention may be necessary.
Uterine atony is a life-threatening medical issue that can develop following childbirth.
It happens due to the incomplete contraction of the uterus after the baby is born and consequently postpartum hemorrhage ensues which can be fatal.
Contractions of the uterus are the usual way that shows to deliver placenta following childbirth and blood vessels connected to the placenta are compressed by these contractions leading to decreased bleeding.
In case of uterine atony, the uterine muscles may not contract hard enough to stop the blood vessels from bleeding resulting in hemorrhage.
At least 75% of postpartum hemorrhage cases and 1 in 40 complicated births in the US are caused by the uterus not contracting effectively after delivery.
Seventy to eighty percent of PPH cases are caused by uterine atony.
One of the causes of uterine atony can be explained by poor muscle tone, which is the condition occurred because of the breakdown of regular muscular contractions.
Other reasons for having uterine atony includes stretching of the uterus, which usually occurs in cases of multiple gestations and large infants, is a key factor that instigates uterine atony.
Long strenuous pains may eventually make the uterus muscles weak.
Retained placental fragments are a common cause.
The uterus that is under infection usually gets in a shift in muscle function as well as failure to release or respond to oxytocin in a normal way.
Instances of uterine atony may occur due to prolonged or preterm labor, hypertensive disorders in pregnancy, uterine distension.
Premature fluid breakage or typical presentation of the fetus inside the womb, magnesium toxicity and increased doses of oxytocin may be the associated factors.
Improper uterine contraction may be the cause of increased levels of fibrin degradation products, uterine inversion among others.
Also, obesity that is represented by a BMI of above 40 is another high-risk factor for postpartum uterine atony.
The recurrence risk may be as high as 15%, compared to the preceding pregnancy cases for women who are previously diagnosed with PPH.
Class III obesity is associated with highest probability of causing a second episode.
The risk of recurrence is partially dependent on the underlying cause.
Recent labor or childbirth and existence of risk factors like uterine atony in prior pregnancies, large baby, extended labor, multiple pregnancies, etc may be included under clinical history.
Uterine Palpation: Following delivery, the uterus may feel swollen and enlarged rather than firm and contracted, as would be expected.
Heavy vaginal bleeding can be observed which might lead to hypovolemia, dro in blood pressure etc.
Examination of the abdomen: Examining for bruises or distention in the abdomen along with size of the uterus, consistency, and tenderness as evaluated by palpation.
Examination of the pelvis: Visual examination for hematomas or perineal cuts should be carried out.
Ultrasound evaluation can be carried out to check for the presence of placental fragments, any retained products, and atony signs.
Ruptured uterus
Coagulopathy
Inversion of the Uterus
Uterine subinvolution
Vascular deformities
The aim of the treatment approach consists of individual steps that help to stabilize the patient, stopping hemorrhage and restoration of the uterine tone.
Depending on the severity of the ailment and the outcome of early interventions, this paradigm might change.
Ensure that well-defined procedures are available in hospitals for handling obstetric emergencies, such as uterine abortion.
Uterotonic drugs should be readily available.
Proper training regarding uterine massage should be given to healthcare professionals.
Administration of pharmaceutical agents with drugs
Oxytocin:
Oxytocin is the primary treatment for uterine atony during cesarean delivery.
It is recommended to be administered immediately after delivery to prevent uterine atony and manage postpartum hemorrhage.
However, the optimal intravenous infusion dose remains controversial and a universal dose is not suitable.
It targets the smooth muscle of the uterus enhancing rhythmic contractions by binding to the dopamine D1 receptor which resulting in a rapid tetanic uterotonic effect, shortening the third stage of labor and reducing blood loss.
Carboprost:
It treats postpartum uterine hemorrhage due to atony and particularly reduces bleeding.
This drug reduces blood loss during surgeries and also in few conditions that involved increased bleeding.
It significantly decreases the mortality and reduce the need for laparotomy in uterine atony.
It is recommended as an adjunct to standard uterotonics by enhancing hemostasis and reducing blood loss without increasing risks to the mother or fetus.
If medications fail and excessive bleeding persists then surgical management is necessary.
Techniques include urinary packing which involves tightly packing the uterus with gauze and inserting a Foley catheter for bladder drainage, and the Bakri balloon which inserts a balloon for bladder drainage.
Surgical management techniques include urinary curettage, uterine artery ligation, compression sutures (B-Lynch), gynecologic oncologist hypogastric artery ligation, and a hysterectomy when other methods fail to control bleeding.
These techniques are efficient and quickly implemented by using rolled gauze ribbons.
The phases of management includes:
Initial prevention
Medical intervention
Tamponade techniques and surgery
If atony occurs despite preventive measures and medical management is necessary by using techniques like oxytocin, methergine, prostaglandins, ergot alkaloids, and misoprostol.
If bleeding persists tamponade techniques are used to apply pressure and stop the bleeding.
If conservative methods fails and surgical intervention may be necessary.
Uterine atony is a life-threatening medical issue that can develop following childbirth.
It happens due to the incomplete contraction of the uterus after the baby is born and consequently postpartum hemorrhage ensues which can be fatal.
Contractions of the uterus are the usual way that shows to deliver placenta following childbirth and blood vessels connected to the placenta are compressed by these contractions leading to decreased bleeding.
In case of uterine atony, the uterine muscles may not contract hard enough to stop the blood vessels from bleeding resulting in hemorrhage.
At least 75% of postpartum hemorrhage cases and 1 in 40 complicated births in the US are caused by the uterus not contracting effectively after delivery.
Seventy to eighty percent of PPH cases are caused by uterine atony.
One of the causes of uterine atony can be explained by poor muscle tone, which is the condition occurred because of the breakdown of regular muscular contractions.
Other reasons for having uterine atony includes stretching of the uterus, which usually occurs in cases of multiple gestations and large infants, is a key factor that instigates uterine atony.
Long strenuous pains may eventually make the uterus muscles weak.
Retained placental fragments are a common cause.
The uterus that is under infection usually gets in a shift in muscle function as well as failure to release or respond to oxytocin in a normal way.
Instances of uterine atony may occur due to prolonged or preterm labor, hypertensive disorders in pregnancy, uterine distension.
Premature fluid breakage or typical presentation of the fetus inside the womb, magnesium toxicity and increased doses of oxytocin may be the associated factors.
Improper uterine contraction may be the cause of increased levels of fibrin degradation products, uterine inversion among others.
Also, obesity that is represented by a BMI of above 40 is another high-risk factor for postpartum uterine atony.
The recurrence risk may be as high as 15%, compared to the preceding pregnancy cases for women who are previously diagnosed with PPH.
Class III obesity is associated with highest probability of causing a second episode.
The risk of recurrence is partially dependent on the underlying cause.
Recent labor or childbirth and existence of risk factors like uterine atony in prior pregnancies, large baby, extended labor, multiple pregnancies, etc may be included under clinical history.
Uterine Palpation: Following delivery, the uterus may feel swollen and enlarged rather than firm and contracted, as would be expected.
Heavy vaginal bleeding can be observed which might lead to hypovolemia, dro in blood pressure etc.
Examination of the abdomen: Examining for bruises or distention in the abdomen along with size of the uterus, consistency, and tenderness as evaluated by palpation.
Examination of the pelvis: Visual examination for hematomas or perineal cuts should be carried out.
Ultrasound evaluation can be carried out to check for the presence of placental fragments, any retained products, and atony signs.
Ruptured uterus
Coagulopathy
Inversion of the Uterus
Uterine subinvolution
Vascular deformities
The aim of the treatment approach consists of individual steps that help to stabilize the patient, stopping hemorrhage and restoration of the uterine tone.
Depending on the severity of the ailment and the outcome of early interventions, this paradigm might change.
Ensure that well-defined procedures are available in hospitals for handling obstetric emergencies, such as uterine abortion.
Uterotonic drugs should be readily available.
Proper training regarding uterine massage should be given to healthcare professionals.
Administration of pharmaceutical agents with drugs
Oxytocin:
Oxytocin is the primary treatment for uterine atony during cesarean delivery.
It is recommended to be administered immediately after delivery to prevent uterine atony and manage postpartum hemorrhage.
However, the optimal intravenous infusion dose remains controversial and a universal dose is not suitable.
It targets the smooth muscle of the uterus enhancing rhythmic contractions by binding to the dopamine D1 receptor which resulting in a rapid tetanic uterotonic effect, shortening the third stage of labor and reducing blood loss.
Carboprost:
It treats postpartum uterine hemorrhage due to atony and particularly reduces bleeding.
This drug reduces blood loss during surgeries and also in few conditions that involved increased bleeding.
It significantly decreases the mortality and reduce the need for laparotomy in uterine atony.
It is recommended as an adjunct to standard uterotonics by enhancing hemostasis and reducing blood loss without increasing risks to the mother or fetus.
If medications fail and excessive bleeding persists then surgical management is necessary.
Techniques include urinary packing which involves tightly packing the uterus with gauze and inserting a Foley catheter for bladder drainage, and the Bakri balloon which inserts a balloon for bladder drainage.
Surgical management techniques include urinary curettage, uterine artery ligation, compression sutures (B-Lynch), gynecologic oncologist hypogastric artery ligation, and a hysterectomy when other methods fail to control bleeding.
These techniques are efficient and quickly implemented by using rolled gauze ribbons.
The phases of management includes:
Initial prevention
Medical intervention
Tamponade techniques and surgery
If atony occurs despite preventive measures and medical management is necessary by using techniques like oxytocin, methergine, prostaglandins, ergot alkaloids, and misoprostol.
If bleeding persists tamponade techniques are used to apply pressure and stop the bleeding.
If conservative methods fails and surgical intervention may be necessary.
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