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, 75-80% of postpartum hemorrhages are due to uterine atony. failure of the myometrium to contract after delivery of the placenta; associated with excessive bleeding from the placental implantation site.

Description
Uterine atony is the most common cause of postpartum hemorrhage and the most common indication for postpartum hysterectomy or blood transfusion.

 Normally, bleeding after delivery is stopped by uterine contractions and compression of the vessels. If uterine contractions are not adequate, bleeding can continue. At times, the uterus is prevented from contracting effectively by fragments of placenta that remain in the uterus after delivery or by benign growths of uterine muscle within the uterine wall (fibroids). In these cases, the term 'atony' usually is not applied. In most cases, the uterine muscle simply fails to contract adequately.

Risk factors
Many factors can contribute to the loss of uterine muscle tone, including:[1] - overdistention of the uterus - multiple gestations - polyhydramnios - fetal macrosomia - prolonged labor - oxytocin augmentation of labor

 - grand multiparity (having given birth 5 or more times) - precipitous labor (labor lasting less than 3 hours) - magnesium sulfate treatment of preeclampsia - chorioamnionitis - halogenated anesthetics - uterine leiomyomata

Causes
Multiple gestation, high parity Fetal macrosomia

Polyhydramnios General anesthetics

Prolonged labor, precipitous labor, augmented labor Infection (chorioamnionitis)

Diagnosis
The presenting signs are a soft uterus with vaginal bleeding. After delivery, uterine atony is detected when there is excessive bleeding and a large, relaxed uterus. Your doctor may perform an examination to be certain that there are no tears of the cervix or the vagina and that all fragments of placenta have been removed from the uterus. Alternate sources of bleeding, such as vaginal or cervical lacerations or retained placental fragments, must be excluded.

Treatment
Initial treatment consists of bimanual compression, uterine massage. Uterine contraction medications: Oxytocin, Methylergonovine, and Prostaglandins Surgery: uterine vessel ligation or hysterectomy (the latter is rarely used) Blood and fluids must be replaced as needed.