Summary about Disease
Uterine atony is a serious postpartum condition where the uterus fails to contract adequately after childbirth. This lack of contraction can lead to severe postpartum hemorrhage, which is excessive bleeding after delivery. It's a leading cause of maternal mortality worldwide. Prompt recognition and treatment are crucial to prevent life-threatening complications.
Symptoms
Excessive vaginal bleeding after childbirth (more than normal for postpartum)
Soft or boggy uterus upon palpation (feeling the abdomen)
Difficulty locating the top of the uterus (fundus)
Clots of blood expelled from the uterus
Signs of shock (rapid heart rate, low blood pressure, dizziness, weakness, paleness)
Causes
Overdistension of the uterus (large baby, multiple gestation, polyhydramnios)
Prolonged or rapid labor
Grand multiparity (having many previous pregnancies)
Use of certain medications during labor (e.g., magnesium sulfate, oxytocin for prolonged periods)
Uterine infection (chorioamnionitis)
Retained placental fragments
Pre-existing uterine abnormalities
Medicine Used
Oxytocin (Pitocin): First-line medication to stimulate uterine contractions.
Methylergonovine (Methergine): Ergot alkaloid that causes uterine contractions. (Contraindicated in patients with hypertension.)
Prostaglandins (Misoprostol, Carboprost): Stimulate uterine contractions. Carboprost is often used when other medications are ineffective. (Carboprost is contraindicated in patients with asthma.)
Tranexamic acid (TXA): An antifibrinolytic agent used to help blood clot and reduce bleeding.
Is Communicable
No, uterine atony is not a communicable disease. It is a complication related to childbirth.
Precautions
While uterine atony itself is not preventable, these precautions can help reduce the risk:
Proper prenatal care to identify risk factors.
Judicious use of labor augmentation medications.
Active management of the third stage of labor (delivery of the placenta) – including administering uterotonic medications proactively.
Thorough examination of the placenta after delivery to ensure it's intact.
Regular postpartum monitoring of uterine tone and vaginal bleeding.
How long does an outbreak last?
Uterine atony is not an "outbreak." It is an acute condition that occurs immediately after childbirth. The acute phase, requiring immediate intervention, typically lasts for several hours after delivery. However, close monitoring needs to continue in the days after childbirth.
How is it diagnosed?
Clinical assessment: Primarily based on observation of excessive postpartum bleeding and palpation of a soft, boggy uterus.
Vital signs: Monitoring heart rate, blood pressure, and oxygen saturation to assess for signs of shock.
Quantification of blood loss: Estimating and measuring the amount of blood lost.
Laboratory tests: Complete blood count (CBC) to assess hemoglobin and hematocrit levels. Coagulation studies may be performed if bleeding is severe or uncontrolled.
Timeline of Symptoms
Immediately after delivery (within the first few minutes to hours): Excessive vaginal bleeding, soft/boggy uterus.
Within hours: If untreated, signs of shock (rapid heart rate, low blood pressure, dizziness).
Continued Monitoring: While the most dangerous period is immediately postpartum, monitoring for heavy bleeding is important in the first 24 hours and even days after delivery.
Important Considerations
Uterine atony is a medical emergency requiring immediate intervention.
Early recognition and prompt treatment are critical to prevent maternal morbidity and mortality.
Multidisciplinary approach involving obstetricians, nurses, anesthesiologists, and blood bank personnel is essential.
If medical management fails, surgical interventions (e.g., uterine compression sutures, arterial ligation, hysterectomy) may be necessary.
Continuous monitoring of vital signs, blood loss, and uterine tone is crucial during and after treatment.