Uterine atony

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Uterine atony
Synonyms	Uterine relaxation
Pronounce	N/A
Specialty	N/A
Symptoms	Postpartum hemorrhage, hypotension, tachycardia
Complications	Hypovolemic shock, anemia, coagulopathy
Onset	Immediately after childbirth
Duration	Variable, depending on treatment
Types	N/A
Causes	Overdistended uterus, prolonged labor, multiple gestation, polyhydramnios, chorioamnionitis, use of uterine relaxants
Risks	Multiparity, prolonged labor, induced labor, general anesthesia
Diagnosis	Clinical assessment, ultrasound
Differential diagnosis	Retained placenta, uterine inversion, lacerations
Prevention	Active management of the third stage of labor, oxytocin administration
Treatment	Uterine massage, uterotonics, surgical intervention
Medication	Oxytocin, misoprostol, carboprost, methylergometrine
Prognosis	Good with prompt treatment
Frequency	Common cause of postpartum hemorrhage
Deaths	N/A

Uterine atony is a medical condition characterized by the failure of the uterus to contract adequately after childbirth. This condition can lead to severe postpartum hemorrhage, which is a significant cause of maternal morbidity and mortality.

Pathophysiology

The uterus is a muscular organ that contracts to help expel the placenta and reduce bleeding after delivery. In cases of uterine atony, the myometrium (the muscular layer of the uterus) fails to contract effectively. This lack of contraction can result in excessive bleeding, as the blood vessels at the placental site remain open.

Causes

Several factors can contribute to uterine atony, including:

• Overdistension of the uterus due to multiple pregnancies, polyhydramnios, or a large baby.
• Prolonged labor or rapid labor.
• Use of tocolytics or magnesium sulfate.
• High parity (having given birth multiple times).
• Chorioamnionitis (infection of the fetal membranes).
• Uterine fibroids.

Diagnosis

The diagnosis of uterine atony is primarily clinical. It is suspected when there is excessive bleeding after delivery and the uterus feels soft and boggy upon palpation. Ultrasound may be used to rule out retained placental fragments or other causes of bleeding.

Management

Management of uterine atony involves several steps:

• Uterine massage to stimulate contractions.
• Administration of uterotonic drugs such as oxytocin, ergometrine, or misoprostol.
• Bimanual compression of the uterus.
• In severe cases, surgical interventions such as uterine artery embolization, compression sutures, or hysterectomy may be necessary.

Prevention

Preventive measures include the active management of the third stage of labor, which involves the administration of uterotonic drugs immediately after the delivery of the baby to promote uterine contractions and reduce the risk of uterine atony.

Prognosis

With prompt and effective management, the prognosis for uterine atony is generally good. However, if not treated promptly, it can lead to severe complications, including hypovolemic shock, coagulopathy, and even maternal death.

See also

• Postpartum hemorrhage
• Uterotonic
• Hysterectomy
• Placenta