Atonia Uteri

Elisa Lestari (PO.62.24.2.15.156)

Eva Savitri (PO.62.24.2.15.158)
Ghia Anindita (PO.62.24.2.15.159)
Gina Mutiara Madyana (PO.62.24.2.15.160)
Mery Oktaviana (PO.62.24.2.15.166)
Nur Indah Puspita Sari (PO.62.24.2.15.)
Ria Deskaranti (PO.62.24.2.15.172)
Wike Anggraeni (PO.62.24.2.15.184)
Yulia Efita Friskila (PO.62.24.2.15.187)
 Definition
Uterine atony is defined as the failure of
the myometrium to contract (Cunningham et al.,
2005). myometrial contractions strong and
effective is very important to stop the bleeding.
Etiology/Risk Factors
Factor associated with uterine overdistension
• Multiple pregnancy
• Polyhydramnios
• Fetal macrosomia

Labor-related factors
• Induction of labor
• Prolonged labor
• Oxytocin augmentation
• Manual removal of placenta
Use of uterine relaxants
• Deep anesthesia
• Magnesium sulfate

Intrinsic factors
• Previous postpartum hemorrhage
• Antepartum hemorrhage
• Obesity
• Age > 35 years
 Pathophysiology
The most common cause of PPH is uterine atony, the
failure of the uterus to contract. primary postpartum
hemorrhage due to atonic uterus occurs when the relaxation of
the myometrium fails to constrict the blood vessels so as to
allow bleeding.
The failure of the uterus associated with placental or
fragment of the placenta, uterus disturbed, or lobes succenturiate
(torn blood vessels in the membranes). The material retained act
as a physical block against a strong uterine contraction needed to
constrict the placental vessels atrelaksasi. However, in many
cases, dysfunctional contraction postpartum retained placenta is
the main reason. It is more likely to be retained placenta in cases
of atonic postpartum hemorrhage, and failure is often the cause
contractions. Distention occurs as the cause of a multiple
pregnancy and polyhydramnios, which also affects the ability of
the uterus to contract good after giving birth and is also a risk
factor for postpartum hemorrhage atonic.
 Massage Uterus
Uterine massage is done by rubbing the
abdominal spirally to stimulate uterine fundus.
Massage stimulates uterine prostaglandin local make
uterine contractions, thereby reducing bleeding (Abdel-
Aleem et al., 2010). A systematic review showed that
the effective uterine massage in preventing PPH.
Women who receive massage the uterus has a lower
amount of bleeding.
 Aorta Compression
Compression of the aorta is a simple
intervention that can be used while preparing the
definitive management or during the transfer of
patients from the district hospital to another tertiary
hospital. It has been proven effective in reducing the
time of resuscitation and also the amount of blood
transfused with minimal side effects were reported.
This simple device can be applied by any health care
provider (with minimal training) will be of great value
in reducing maternal morbidity and mortality.
 Bimanual Compression
Bimanual compression is used only in
cases of heavy primary postpartum
haemorrhage (PPH), as a last resort when all
else has failed to save the mother's life.
Primary PPH occur within 24 hours of
delivery and is bleeding from the genital
tract or greater than 500 ml, or enough to
cause hypovolemic shock.
 Tamponade Uterus

Indications are mounting tampon uterus

for the cause of postpartum hemorrhage
atonic. Bakri balloon is the only device that
is designed specifically for uterine tampon.
Tampon is equipped with a large drainage
channel that allows drainage of blood from
the uterine cavity.
Capacity Tampon Uterus
a. Rusch catheter has a capacity of 1500 ml of
fluid
b. Bakri balloon has a capacity of 500 ml
c. Condom catheter has a capacity of 300 ml
d. Foley catheter has a capacity of 30 ml
PHARMACOLOGY STRATEGY
Effective uterine contractions that are
essential to ensure hemostasis after delivery.
Some effective uterotonic agent to ensure the
myometrium contractility thus avoiding
surgical intervention.
1. Oksitosin
2. Carbetocin
3. Misoprostol
4. Ergometrin
5. Carboprost/Haemabate
Sekian dan