Uterine atony is a contraction weakness of the uterine muscles, which can occur after the birth of the child. The uterus then does not contract, which can result in life-threatening blood loss. It is the leading cause of maternal death after childbirth.
What is uterine atony?
In medicine, the womb is called the uterus. Atony means a muscle relaxation. The uterine atony describes a relaxation of the uterus, which can have life-threatening consequences for the mother. It can occur after the birth of the child when the uterine muscles do not contract or contract only partially. In this case, the uterus is soft and palpable from the outside, which is painful for the patient. For leriche syndrome 101, please visit photionary.com.
In the mother, the lack of contraction results in an above-average blood loss, since the blood vessels cannot close in this way. An above-average amount of blood escapes through the permanent opening. In most cases, the placenta has either only partially detached itself from the wall of the uterus or not at all, which is referred to as a dissolution disorder. Other reasons have also been proven.
The most common cause of uterine atony is failure of the placenta to detach from the uterine wall. Here, the placenta is either not ejected at all or only partially. The bleeding placenta or its remaining remnants remain in the uterus. This can be caused by adhesion of the placenta to the wall of the uterus when it penetrates into the muscular layer.
If the placenta grows on an old scar, for example caused by the removal of a tumor or a previous caesarean birth, it can only result in a partial solution. A spasm of the internal cervix can hold the placenta in place. In this case, it is referred to as a stuck placenta or placenta incarcerata.
Another cause of the regression disorder can be an overstretching of the uterus. It is triggered by a larger than average child, multiple pregnancies or a lot of amniotic fluid. Many births are as taxing on the uterus as cesarean deliveries are. Forceps or suction cups, which are used as an aid during the birth of the child, can also overstretch the uterus.
A subsequent contraction is then made more difficult. If the birth lasts for a long time or if certain anesthetic gases are used, this can also affect the regression properties of the uterus. If so-called fibroids, i.e. benign tumors, are detected in the muscle layer of the uterus before pregnancy or if there is an anatomical malformation of the uterus, they can result in atony.
Symptoms, Ailments & Signs
If the placenta is expelled about half an hour after birth, it is important to first check that it is complete. If it isn’t, it can lead to surges of bleeding from the vagina. The mother’s circulation often collapses quite quickly and a state of shock occurs.
Diagnosis & course of disease
If the placenta has not been expelled an hour after the birth of the child, action must be taken. The uterus in this case is soft and usually located above the navel. If pressure is exerted on her, the patient experiences this as painful.
A uterine atony can cause serious complications. First, there is a risk of heavy bleeding during childbirth. This can lead to circulatory problems, anemia and occasionally shock.
Accompanying this, the mother usually feels severe pain, which can make the birth process difficult. In most cases, sedatives have to be administered, which are associated with health risks for the child and the mother. If the course is severe, the child cannot be born via the normal birth route, but can be born by means of a caesarean section.
Although this is a routine procedure, complications can occur. There is a risk that the internal organs, especially the bladder, intestines and uterus, will be injured. Infections and severe blood loss can also occur. After the operation, the affected women occasionally suffer from wound healing disorders or scar pain.
Sometimes the wound can open up again and then has to be closed again within a second procedure. In addition, the prescribed sedatives and painkillers are always associated with certain side effects and interactions. People with allergies may experience an allergic shock.
When should you go to the doctor?
In the case of uterine atony, a doctor must usually always be consulted. The disease itself is usually recognized by a doctor before birth or directly during birth and then treated. However, uterine atony cannot always be treated completely, so that in some cases the child dies. The further course cannot be predicted in general. A doctor should be contacted if there is excessive bleeding in the vaginal area immediately after birth. The affected mother can also lose consciousness and must be treated by an emergency doctor.
Since the atony of the uterus can also lead to the death of the child, psychological care for the parents and relatives is often necessary. This can prevent mental upsets or depression. Therefore, even after the death of the child, a psychologist should be consulted. If the atony of the uterus is treated successfully, regular examinations by a doctor are usually necessary even after the treatment.
Treatment & Therapy
If the placenta has been expelled incompletely, the remains must be removed by scraping. This is usually done under anesthesia as it can be painful. If the placenta has been expelled completely and the uterus still does not contract, medication is administered first. They are called uterotonics and are contractile agents that contain active ingredients such as oxytocin or methylergometrine to support the muscles of the uterus.
The contents of the uterus are then expressed so that the internal resistance is not so great and the muscles are also stimulated by movement. The mother’s bladder is also emptied. Cold stimuli by applying cooling elements also support the contracting movement of the muscles. The Credé maneuver applied from the outside supports the detachment of the placenta.
If this does not lead to the desired success, the Hamilton maneuver is used. The whole hand is inserted into the woman’s vagina. It is clenched into a fist with the knuckles pointing toward the front wall of the uterus. The other hand also exerts pressure on the uterus from the outside. She erects the uterus and presses it against the inner fist and the pubic bone. This supports the compression of the uterus, which causes the large vessels to close. This is to prevent the uterus from filling up with blood.
A massage of the uterus should complete the contraction of the uterus. However, it can cause after-pains that can last up to two hours. If all efforts have failed at this point, the last resort to save the mother’s life is removal of the uterus.
The patient herself cannot do much to prevent uterine atony apart from going to regular check-ups. During and after a cesarean birth, the doctor treating you can administer appropriate medication such as carbetocin or oxytocin to support the detachment of the placenta. It should also be borne in mind that an elective caesarean section is not recommended, as this type of birth promotes uterine atony.
In the case of uterine atony, the extent of the follow-up measures is determined by the severity of the bleeding. “Lighter” peripartum bleeding (bleeding volumes up to 1000 ml) can be stopped regularly with conservative therapy (manual uterine compression, uterine tamponade, uterine compression sutures or medication such as oxytocin). Follow-up care is then reduced to a maximum of two gynecological follow-up examinations (clinical or outpatient).
In addition to the visual follow-up check, an examination of the abdominal cavity using ultrasound is usually carried out during the follow-up examinations. In addition, further examinations are planned for midwifery care. Complications that may occur as a late consequence can thus be recognized and treated at an early stage. In the event of vaginal bleeding for no apparent reason, the affected person must be presented to a doctor immediately.
“Heavy” peripartum bleeding (bleeding over 1000 milliliters) can only be treated surgically. The placenta is released manually. Postoperative abdominal pain is to be expected. Strong painkillers are required. Antibiotic therapy may help the surgical wound to heal. In the event of an operation, the secondary task of aftercare is to guarantee the care and attention of the newborn child.
The affected person will not be able to master these tasks due to the high blood loss during birth and the surgical intervention. After the hospital stay, further gynecological examinations using ultrasound are necessary for the follow-up of the surgical wound. Psychotherapeutic counseling is also recommended for both parents.
You can do that yourself
Atony of the uterus is always treated by the responsible doctor or obstetrician. Depending on the course of the procedure, a Credé maneuver or the manual activation of labor may already be sufficient to stimulate the contraction of the uterine muscles sufficiently. In severe cases, an operation may be necessary.
After the birth process, the complaints must be treated individually. In addition to general measures such as rest and relaxation, affected women must pay attention to careful intimate hygiene. If bleeding or other symptoms continue to occur, the doctor must be informed.
If the atony of the uterus is severe, there is a risk of death for the patient. There may be a birth trauma that needs to be worked through. It is best for affected women to talk to their gynecologist, who can put you in touch with a suitable therapist.
Since birth trauma can disrupt the emotional connection between mother and child, patients often need the support of a specialist or friends and acquaintances in the first few months in raising the child. Associations such as the midwives network processing birth or shadow and light e. V. provide the affected women with further self-help measures and contact points.