Uterine atony is a clinical situation that occurs after childbirth, when the contractile capacity of the uterine muscle is severely limited. 90 percent of uterine atony leads to postpartum hemorrhage, which is life-threatening. Treatment of uterine paresis consists in stimulating the uterus to work as quickly as possible, which helps to evacuate the remains of the placenta, and also inhibits bleeding, which is a preventive procedure against hemorrhagic shock.

Uterine atony( uterine paresis ,uterine hypotension ) is the main cause of postpartum hemorrhage . Improper contraction of the uterus and vascular bed may lead to rapid blood loss (in full-term pregnancy, about 1/5 of the total cardiac output - about 1000 ml / min of blood - goes to placental circulation) and hemorrhagic shock.

Uterine atony: risk factors

An attempt was made to establish the predictors of uterine paresis. The way of termination of pregnancy does not matter, this complication occurs with the same frequency after delivery by means of natural means, forceps delivery or after traditional caesarean section. The list of predictors includes:

  • uterine overstretching: polyhydramnios, fetal macrosomia, multiple pregnancy
  • course of labor: induction of labor, prolonged labor, induction of labor with the use of oxytocin, manual extraction of the placenta
  • use of preparations that have a direct impact on uterine muscle tone, i.e. β-mimetics, nifedipine - relatively often used as part of preterm labor therapy
  • other: history of obstetric haemorrhage, obesity, uterine fibroids

The presence of risk factors for uterine paresis obliges the obstetrician in labor to take measures to prevent the pathology in question.

This involves the administration of pharmacological agents that contract the uterine muscle during the third stage of labor or the early tightening of the umbilical cord after delivery.

Prophylactic administration of oxytocin has been the subject of many discussions among experts, as a result of which it has been established that the actual administration of oxytocin reduces the likelihood of postpartum hemorrhage as a result of abnormal contraction of the muscleuterus.

Uterine atony: symptoms

Correctly contracted uterus after delivery is hard, dense, clearly demarcated from neighboring structures, flattened antero-posteriorly.

In turn, the atony of the uterus is characterized by excessive flaccidity and the inability to establish clear boundaries. Blood pools in the uterine cavity, which further causes it to stretch.

With this type of hemorrhage, you need to be aware that the assessment of the amount of blood leaving the uterine cavity is not adequate to the actual amount of blood lost, because much more blood fills the uterine cavity. In addition to bleeding, other clinical symptoms include:

  • puerperal excrements with a lot of clots
  • tachycardia
  • low blood pressure
  • weakness
  • sometimes fainting, loss of consciousness

Bleeding resulting from paresis of the uterine muscle should be differentiated from other causes of hemorrhage, ie postpartum injuries within the cervix or vaginal vault. Haematological disorders should be ruled out in the patient (haemophilia A or B, von Willebrand disease).

Uterine atony: drug treatment

The aim of the therapeutic procedure is to stimulate the uterus to contract and empty the uterine cavity as quickly as possible. As a result, not only is the placental debris evacuated, but bleeding is also inhibited.

In many cases, such a significant blood loss is an indication for an equivalent blood volume transfusion. The first-line treatment is pharmacological treatment.

The most commonly used drugs include: oxytocin, carbetocin, misoprostol - the most frequently chosen one is still oxytocin, administered as a continuous infusion.

The clinical effect lasts up to 60 minutes. Overdosing of the drug leads to water poisoning, which is manifested by severe headache, vomiting, convulsions, and in extreme cases - disturbance of consciousness. Therefore, it is important to control the fluid balance to avoid overhydration.

Uterine atony: drug treatment

  • revision of the uterine cavity- searching for other causes of excessive blood loss, i.e. cervical trauma, as well as emptying the uterine cavity from the remains of the placenta
  • uterine tamponade- it should be considered in patients after ineffective pharmacological treatment, now a Bakri balloon is the tool for tamponade, placing the balloon should not be a problem - it is enough to fill it with 300 - 500 ml, which should stop the bleeding, with balloon therapy failingindication for exploratory laparotomy
  • massage of the uterus- obstetrician's hand placed at the level of the uterine floor, and in the case of the two-handed variant, the inner hand should compress the anterior vaginal vault
  • exploratory laparotomy- allows direct massage of the uterine muscle, not through the shell, and thanks to it, it is possible to inject prostaglandins directly into the uterine muscle, which accelerates contraction - if such a procedure turns out to be not very effective, it is necessary to apply hemostatic sutures that stop the bleeding by applying adequate pressure; the suture used to reduce bleeding is called the B-Lynch suture, the essence of which is to bring the front wall of the uterus closer to the back, which ensures constant pressure

The method of last resort is the removal of the uterus, which should be performed only as a last resort, when other forms of therapeutic treatment are not effective. In any case, before starting the procedure, you should discuss her future maternal plans with the patient.

Category:

Pregnancy