Case Analysis

UTERINE ATONY

VILLAMIL, MICAELLA B.
Ms. Hazel Tanagon, RN
NUR03B
 INTRODUCTION
The term "uterine atony" describes a fragile, frail uterus following delivery. It occurs when your uterine muscles
aren't sufficiently contracted to seal the placental blood veins after delivery. Blood veins in the uterus burst open
after childbirth, allowing the placenta to separate from the uterine wall. Contractions aid in sealing up the blood
vessels. And therefore, if the uterine muscles do not contract, it may cause a life-threatening blood loss condition
called postpartum hemorrhage. Additionally, uterine atony can develop as a side effect of vaginal delivery or C-
sections, as well as during miscarriage or other uterine procedures.
Moreover, 70% of postpartum bleeding is associated with uterine atony and it ranks among the top 5 causes of
maternal death on a global scale. And in point of fact, uterine atony can occur more than once. If one already had
uterine atony, this individual's risk is increased.
There are many risk factors for uterine atony. The mother may be having her first child, her fifth or more children,
twins, triplets, or more; her baby may be larger than typical (fetal macrosomia); she may be over 35; she may have
too much amniotic fluid, or polyhydramnios; she may be obese; or she may have uterine fibroids. Healthcare
professionals also think the mother could have a difficult labor, a long or quick labor, an induced labor, have
chorioamnionitis, have received general anesthesia, or have an enlarged uterus during delivery. If more than two risk
factors are present, the mother may be at high risk for uterine atony. Healthcare professionals can get ready before
birth for patients for whom problems are identified so that they are prepared to act quickly.
The main symptom of uterine atony is persistent or heavy uterine bleeding. Most occurrences of uterine atony are
discovered by your healthcare professional shortly after your baby is delivered. Your uterus is also weak, loose, and
relaxed after giving birth. Low blood pressure, a rapid heartbeat, feeling lightheaded or weak, a pale complexion,
losing consciousness, being unable to urinate, and discomfort, particularly in the back, are some possible symptoms.

Anatomy and Physiology

The uterus is a muscular organ with a thick wall
that is located in the center of the abdominal
pelvic cavity. It has three layers: the
perimetrium, the myometrium, and the
endometrium, which is the innermost layer
(outermost layer). Depending on hormonal
stimulation, the endometrium's thickness and
shape change.

The fundus, corpus, isthmus, and cervix are the

four components of the uterus. The isthmus
joins the corpus, the biggest part, to the cervix.
The uterine body and vaginal lumen are
connected via the cervix. Prior to the rectum
and behind the bladder is where the uterus is
located.
 Cervical Laceration
The lateral sides of the cervix, along the
branches of the uterine artery, are where cervical
lacerations are most frequently found. A burst
artery may cause blood loss that is so severe that
it oozes out of the vaginal hole. This arterial
bleeding is a brighter crimson than the venous
blood lost during uterine atony. In 16,931 vaginal
births, there were 32 cervical lacerations, which
Vaginal Laceration
Vaginal lacerations are simpler to spot than
cervical lacerations. It is difficult to stitch up
vaginal lacerations because vaginal tissue is
friable. A balloon tapenade, similar to that used
with uterine hemorrhages, may be effective if
suturing is unable to induce hemostasis.

is a 0.2% rate. Therapeutic Management

There is typically considerable leakage after a
Therapeutic Management
When repairing a cervical laceration with
sutures, which is frequently necessary due to
excessive bleeding, the region must often be
seen well. If the cervical laceration looks to be
significant or difficult to heal, a localized
anesthetic may be given to the patient to relax
the uterine muscle and relieve pain. Assure the
mother that her baby is okay and provide her
comfort. Give the mother advance notice that she
will need to remain in the delivery room while the
vaginal repair, thus the vagina may be packed to
maintain pressure on the suture line. It may be
necessary to install a Foley catheter (an indwelling
urine catheter) because the packing places so
much more pressure on the urethra that urinating
can be challenging. Make careful to note the
patient's records and the location of the packing
so that it may be removed to avoid infection after
24 to 48 hours or before the patient is released
from the hospital.

primary healthcare professional places sutures.

Perineal Laceration

When giving birth in the

lithotomy position as compared to
the supine position, a mother is
more likely to sustain perineum
lacerations because the lithotomy
posture creates more stress on the
perineum. Perineal lacerations can
be one of four types, depending on
the size and depth of the damaged
tissue.

 Second Degree
First Degree

Most usually occurs during labor. In this
Has an impact on the first layer of tissue instance, the rip is a little bigger and extends
deeper through the skin into the muscles of the
that surrounds the perineum and vagina.
vagina and perineum.

Third Degree Fourth Degree

The vagina to the anus are connected by a third- A fourth-degree rip is the least frequent
degree tear. In this type of tear, the skin and
form of birth-related tear. This type of tear,
muscles of the perineal region, as well as the
which extends from the vagina through the
anal sphincter muscles, are affected. These
muscles are in charge of controlling bowel anal sphincter muscles and perineal area
motions. and into the rectum, is the most severe.

Therapeutic Management
Perineal lacerations receive the same care when it comes to suturing as an episiotomy repair. Make sure the degree of
laceration is noted since women with fourth-degree lacerations need special attention to avoid sutures coming undone or
getting infected. Sutured lacerations and episiotomy wounds often heal in the same amount of time. For the first week after
delivery, a diet heavy in fluids and a stool softener may be suggested to prevent constipation and hard stools, which might
rupture the new sutures. Enema or rectal suppository are not recommended since the hard ends of the equipment might
open sutures that are near to or even include those of the rectal sphincter. Fourth-degree lacerations often heal without any
additional issues, despite the likelihood of long-term dyspareunia, rectal incontinence, or sexual discomfort.
Medical Management
DIAGNOSTIC AND LABORATORY PROCEDURES
Medical Management

IVF, 02 THERAPY, NEBULIZATION, NGT

Medical Management
MEDICATIONS
Medical Management
MEDICATIONS
 Medical Management

DIET
 Medical Management

ACTIVITY
 Medical Management
SURGICAL MANAGEMENT (APPLICABLE TO PATIENTS WHO HAD SURGERY)
 Nursing Management
Nursing Care Plan
 Learning Derive

Postpartum hemorrhage, an obstetric emergency and possibly deadly

condition that can happen after pregnancy, is mostly caused by uterine
atony. The prenatal care team must treat the mother right away if she
develops this dangerous condition to prevent excessive blood loss.
Additionally, being aware of a person's risk in advance might help them
get ready for emergency treatment should they require it. Therefore,
nurses should talk to the mother about the birthing process, give her
advice on what to expect, offer emotional support, and instruct the
expectant mother and her family on the physiological and psychological
changes that occur during pregnancy, the development of the fetus,
labor and delivery, and how to care for the newborn.