Uterine Atony (Postpartum)

Chapter 224 Uterine Atony (Postpartum)



INTRODUCTION



Description: Uterine atony is loss of uterine tone after delivery that often presents as postpartum hemorrhage.

Prevalence: Hemorrhage is seen in 5% of deliveries, mostly because of atony; milder degrees are more common.

Predominant Age: Reproductive.

Genetics: No genetic pattern.


ETIOLOGY AND PATHOGENESIS



Causes: Loss of the normal uterine contractile forces.

Risk Factors: Multiparity (grand multiparity), uterine overdistention (multiple birth, polyhydramnios), prolonged labor, prolonged oxytocin stimulation, muscle-relaxant agents (MgSO4, tocolytics), rapid labor, chorioamnionitis, retained placental tissue.


CLINICAL CHARACTERISTICS



Signs and Symptoms



• Bright-red vaginal bleeding

• Loss of uterine tone palpable on abdominal examination

• Tachycardia, hypotension, and vascular collapse possible


DIAGNOSTIC APPROACH



Differential Diagnosis



• Retained placental fragments

• Genital tract lacerations (cervical, vaginal)

• Uterine rupture

• Uterine inversion

• Coagulopathy


Associated Conditions: Uterine inversion and postpartum hemorrhage.


Workup and Evaluation



Laboratory: Hemoglobin or hematocrit to monitor status and volume of blood loss.

Imaging: Ultrasonography may be used to identify retained placental products but is generally not necessary.

Special Tests: None indicated.

Diagnostic Procedures: Physical examination (abdomen and vagina).


Pathologic Findings


Hemoglobin and hematocrit concentrations will not reflect the volume of blood lost until after equilibration has taken place at 6 to 24 hours.



MANAGEMENT AND THERAPY



Nonpharmacologic



General Measures:

Related posts:

  1. Anemia
  2. Toxic Shock Syndrome
  3. Uterine Anomalies: Bicornuate, Septate, and Unicornuate Uterus
  4. Cervical Cancer

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Jun 6, 2016 | Posted by in GYNECOLOGY | Comments Off on Uterine Atony (Postpartum)

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