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.
Uterine atony failure of the myometrium to contract after delivery of the placenta; associated
with excessive bleeding from the placental implantation site.
Before Delivery
If you are at risk for uterine atony, your doctor or nurse should make the following
preparations in case excessive bleeding occurs during or after delivery:
at least one large intravenous line should be established%
medication to induce contractions of the uterus--oxytocin (Pitocin), methylergonovine
(Methergine), and or prostaglandins--should be on hand, and
appropriate nursing and anesthesia personnel should be available.
In addition, the blood bank should be notified of the possible need for a blood transfusion
for certain high risk patients.
After Delivery
Uterine atony is diagnosed after delivery when there is excessive bleeding and a large,
relaxed uterus. The doctor first rules out other potential causes of the bleeding (tears in the
vagina or cervix and fragments of the placenta remaining in the uterus); these problems should
be resolved if they are present. If the bleeding continues, the uterus may be stimulated to contract
with use of massage and intravenous oxytocin. Many studies show this technique reduces
postpartum hemorrhage and the need for blood transfusions. If heavy bleeding from atony occurs
despite the use of oxytocin after delivery, then two additional medications may be used to help
control hemorrhage:
Methylergonovine, a strong vasoconstrictor derived from ergot, is injected into a
muscle. it is not given to patients with preeclampsia or a history of high blood
pressure because it can cause high blood pressure.
Prostaglandin F-2-alpha (Hemabate) is injected under the skin and also directly
into the uterus. Frequent side effects include diarrhea and vomiting. It can cause
bronchial constriction and is usually avoided in patients with asthma. Emergency
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. If successful, this procedure should not affect future pregnancies. In a more
involved procedure, the doctor uses x-rays to guide a small catheter through blood
vessels in the mother6s leg and into the blood vessels supplying the uterus. These
blood vessels are then injected with gelatin sponge particles or spring coils to obstruct
blood flow to the uterus. Although successful control of hemorrhage has been
reported with this technique, the equipment necessary to perform it may not be
available in most emergency situations.
If bleeding persists in spite of all conservative measures to control it, a hysterectomy
(removal of the uterus) may be necessary.
Medical Treatment
1. Intervenously fluids administered to increase fluid and blood volume.
2. Oxytocin administration.
3. Methergine/prostin may be administered to stimulate uterine contractions when oxytocin
is ineffective.
4. blood transfusion if the patients hematocrit drops too low and/or if she is symptomatic.
Nursing Interventions
1. Palpate the fundus frequently to determine continued muscle tone.
2. Massage the fundus, if boggy, until firm (do not over massage, this fatigues the muscle).
3. Monitor patients vital signs every 85 minutes until stable.
4. Prevent bladder distention. Bladder distention displaces the uterus and prevents effective
uterine contractions.
Nursing Diagnosis
- Def i ci ent f l ui d vol ume r el at ed t o pos t par t um hemor r hage
- Acut e pai n r el at ed t o ut er i ne cr ampi ng and per i neal pai n
exper i enced
- Ri s k f or i nef f ect i ve t i s s ue per f us i on r el at ed t o hemmor hage