Uterine atony

Uterine atony is a loss of tone in the uterine musculature. Normally, contraction of the uterine muscle
compresses the vessels and reduces flow. This increases the likelihood of coagulation and prevents bleeds. Thus,
lack of uterine muscle contraction can cause an acute hemorrhage. Clinically, 75!"# of postpartum
hemorrhages are due to uterine atony.
Uterine atony$ failure of the myometrium to contract after delivery of the placenta% associated with e&cessive
bleeding from the placental implantation site.
Before Delivery
'f you are at risk for uterine atony, your doctor or nurse should make the following preparations in case
e&cessive bleeding occurs during or after delivery$
at least one large intravenous line should be established%
medication to induce contractions of the uteruso&ytocin ()itocin*, methylergonovine (+ethergine*,
and,or prostaglandinsshould be on hand% and
appropriate nursing and anesthesia personnel should be available.
'n addition, the blood bank should be notified of the possible need for a blood transfusion for certain highrisk
patients.
After Delivery
Uterine atony is diagnosed after delivery when there is e&cessive bleeding and a large, rela&ed uterus. The
doctor first rules out other potential causes of the bleeding (tears in the vagina or cervi& and fragments of the
placenta remaining in the uterus*% these problems should be resolved if they are present. 'f the bleeding
continues, the uterus may be stimulated to contract with use of massage and intravenous o&ytocin. +any studies
show this techni-ue reduces postpartum hemorrhage and the need for blood transfusions. 'f heavy bleeding
from atony occurs despite the use of o&ytocin after delivery, then two additional medications may be used to
help control hemorrhage$
+ethylergonovine, a strong vasoconstrictor derived from ergot, is in.ected into a muscle. 't is not given
to patients with preeclampsia or a history of high blood pressure because it can cause high blood
pressure.
)rostaglandin /0alpha (1emabate* is in.ected under the skin and also directly into the uterus. /re-uent
side effects include diarrhea and vomiting. 't can cause bronchial constriction and is usually avoided in
patients with asthma.
2mergency surgery should be performed if atony persists despite these measures to control the bleeding. This
may be accomplished by tying off the blood vessels that supply the uterus. 'f successful, this procedure should
not affect future pregnancies. 'n a more involved procedure, the doctor uses &rays to guide a small catheter
through blood vessels in the mother3s leg and into the blood vessels supplying the uterus. These blood vessels
are then in.ected with gelatin sponge particles or spring coils to obstruct blood flow to the uterus. 4lthough
successful control of hemorrhage has been reported with this techni-ue, the e-uipment necessary to perform it
may not be available in most emergency situations.
'f bleeding persists in spite of all conservative measures to control it, a hysterectomy (removal of the uterus*
may be necessary.
Medical treatment.
(a* 'ntervenously fluids administered to increase fluid and blood volume.
(b* 5&ytocin administration.
(c* +ethergine,prostin may be administered to stimulate uterine contractions when o&ytocin is ineffective.
(d* 6lood transfusion if the patient3s hematocrit drops too low and,or if she is symptomatic.
Nursing interventions.
(a* )alpate the fundus fre-uently to determine continued muscle tone.
(b* +assage the fundus, if boggy, until firm (do not over massage, this fatigues the muscle*.
(c* +onitor patient3s vital signs every 75 minutes until stable.
(d* )revent bladder distention. 6ladder distention displaces the uterus and prevents effective uterine
contractions.
N89 :;$
:eficient fluid volume realted to postpartum hemmorhage
4cute pain related to uterine cramping and perineal pain e&perienced
<isk for ineffective tissue perfusion related to hemmorhage