Uterine Atony – Reasons, Signs, and Treatment

Uterine atony or atony of the uterus is a serious condition that can happen after childbirth. Uterine atony is a life-threatening condition and can result in maternal death. Immediate treatment is required if a woman goes experiences this condition. Read on to know more about this condition.

What Is Atony of the Uterus?

Uterine atony, in medical terms, means the loss of tone in the uterine musculature. During labour, uterine muscles contract compressing the blood vessels and reducing the blood flow. This, in turn, increases the likelihood of coagulation and prevents haemorrhage. But when the uterus fails to contract after the delivery, it is known as atony of the uterus and this can lead to postpartum haemorrhage. It has been proved that 75%-80% of postpartum haemorrhages are due to uterine atony.

Causes of Uterine Atony

There are many factors which prevent the muscles of the uterus from contracting after labour. Some of the most common causes of uterine atony are mentioned below.

• Prolonged labour or delayed labour
• Rapid labour
• Overdistention of the uterus (enlargement of the uterus) because of the presence of excess amniotic fluid ( a condition called as polyhydramnios) or a large baby
• Administration of oxytocin, general anaesthesia or other drugs during labour
• Inducing labour using medication

There is a potential for an increased risk of the atony of the uterus if the below-mentioned factors exist –

• Multiple pregnancies or delivering twins or triplets
• Have had many previous deliveries
• Fetal macrosomia where the baby is larger than average
• If delivery was assisted using forceps or vacuum
• You are over 35 years of age
• You are medically classified as obese

The factors mentioned above are some of the causes which pose a risk of postpartum haemorrhage according to their severity. The risk for uterine atony is not the only cause of postpartum haemorrhage; it could occur in women who have had no risk factors at all.

Signs and Symptoms of the Uterine Atony

The most common and foremost symptom of uterine atony is that the uterus remains relaxed and without any tension after giving birth. Atony of the uterus is the primary cause of postpartum haemorrhage. Postpartum haemorrhage is excessive bleeding post-delivery and occurs after the placenta is delivered. About 1%-5% of women have a postpartum haemorrhage, and a loss of more than 500 millilitres of blood after delivery of the placenta is defined as postpartum haemorrhage. With most haemorrhages occurring right after delivery (especially in caesarean births), the symptoms include:

• Uncontrollable and excessive bleeding post-delivery of a baby
• A drop in blood pressure
• An increase in the heart rate
• Pain
• Back pain

Diagnosing Atony of the Uterus

Uterine atony is diagnosed when the uterus is soft, relaxed and there is an excess bleeding post giving birth to a baby. A doctor may be able to estimate the loss of blood by counting the number of saturated pads or weighing the sponges that are used to absorb blood. A physical examination by the doctor will help rule out other causes of bleeding like a tear in the cervix or pieces of the placenta in the uterus. The doctor will also keep a watch for the following.

• Pulse rate
• Blood pressure
• Count of red blood cells
• Factors for clotting of blood

Complications

Apart from insufficient uterine contraction, other complications of uterine atony include –

• Giddiness, dizziness, or light-headedness, due to low blood pressure generally termed as orthostatic hypotension
• Anaemia
• Fatigue and tiredness

Anaemia or fatigue after birth increases the chances of a mother experiencing postpartum depression. An uncontrolled and excessive loss of blood than the normal could lead to hemorrhagic shock. If blood loss is not monitored, then it could lead to a life-threatening situation.

Treatment

The first treatment is intended to stop the bleeding and replace the blood that has been lost. Medical experts ensure that the mother is given IV fluids, blood and blood products without any delay.

Other modes of treatment include:

• A uterine massage, where the doctor places one hand in the vagina pushing against the uterus with the other hand over the abdominal wall compressing the uterus.
• Prescribed uterotonic drugs including oxytocin, methylergonovine and prostaglandins
• Blood transfusions

In cases where the condition is severe, treatment includes

• A surgery to tie the blood vessels.
• Uterine Artery Embolization – It involves injecting minute and small particles into the uterine artery to impede blood flow to the uterus.
• Hysterectomy, if all other treatments fail

Outlook for the People With Uterine Atony

Countries with limited healthcare facilities have higher death instances caused due to postpartum haemorrhage. The risk of death increases due to delay in diagnosis, delay in access to a medical facility and delay in receiving the recommended treatment. If the diagnosis and treatment happen on time, there is a less likelihood of complication.

Can Uterine Atony Be Prevented?

No, uterine atony cannot be prevented, but a doctor can help manage the condition through all the stages of labour. If there is a presence of risk, then appropriate uterine atony nursing management procedures must be in place. The medical facility should have IV lines ready, prescribed medications handy, and the equipment to deal with blood loss.

Vital signs of the amount of bleeding occurred after birth must be monitored by the doctor to detect haemorrhage. Oxytocin is the first line of treatment suggested to help the uterus contract after delivery. Uterine massage has now become a common practice post-delivery of the placenta to reduce the risk of symptoms of uterine atony. Taking a regulated dose of prenatal vitamins and iron supplements can also help in preventing anaemia and other complications of postpartum uterine atony.

Uterine atony is the main cause of primary postpartum haemorrhage, a condition marked by excessive bleeding. Scheduled and constant monitoring of the patient, access to a well-equipped hospital, availability of blood, blood products, drugs and the presence of competent medical staff at the time of delivery is vital for the diagnosis and prognosis of uterine atony.

Also Read: Complications during Labour and Delivery