UTERINE ATONY

Cudanin, Regine
R.
Kimaykimay,
Angeline P.
>Relaxation of the uterus
>The most frequent cause of postpartum hemorrhage

Tends to occur most often in:

• Asian
• Hispanic
• Black Woman
Factors/Conditions That Increases A Woman’s Risk For
Poor Uterine Tone Leading To Postpatal Hemorrhage:

Conditions that distend the • Multiple gestation

uterus beyond average • Polyhydramnios (excessive
capacity amount of amniotic fluid)
• A large baby (>9 lb)
• The presence of uterine
myomas (fibroid tumors)
Conditions that could • An operative birth
have caused cervical or • A rapid birth
uterine lacerations
Conditions with varied • Placenta previa
placental site or attachment • Placenta accrete
• Premature separation of
the placenta
• Retained placental
fragments
Conditions that leave the • Deep anesthesia or analgesia
uterus unable to contract • Labor initiated or assisted with
an oxytocin agent
readily • High parity or maternal age
over 35 years of age
• Previous uterine surgery
• Prolonged and difficult labor
• Chorioamnionitis or
endometritis
• Secondary maternal illness such
as anemia
• Prior history of postpartum
hemorrhage
Conditions that lead to • Fetal death
inadequate blood coagulation
• Disseminated
intravascular
coagulation (DIC)
NURSING DIAGNOSES AND RELATED
INTERVENTIONS
Nursing Diagnosis:
- Deficient fluid volume related to excessive blood
loss after birth.
Outcome Evaluation:
- Patient’s blood pressure and heart rate remains
within usual defined limits; lochia flow is less
than one saturated perineal pad per hour.
If the loss of blood is extremely copious, a
woman will quickly begin to exhibit
symptoms of hypovolemic shock:
>Falling blood pressure
>rapid, weak, or thready pulse
>increased and shallow respirations
>pale, clammy skin
>increasing anxiety
If the blood loss is unnoticed seepage, there is
little change in pulse and blood pressure at first
because of circulatory compensation.
• A woman will have lost approximately 250ml of blood
• When you are counting perineal pads, you differentiate
between saturated and used.
Most advisable way to measure blood loss:
• Weighing perineal pads before and after use.
- Then simply subtract the weight of the pad itself
when we weigh the pad that has been used/with
blood.

Always be sure to turn a woman on her side when

inspecting for blood loss to be certain a large amount
of blood is not pooling undetected beneath her.
The best safeguard against uterine atony is to:
• Palpate a woman’s fundus at frequent intervals to
be assured her uterus is remaining contracted.

Well-contracted uterus = feels firm and is easily

recognized.
Relaxed uterus = unsure whether you have
located a woman’s fundus on palpation or not
Frequent assessments of lochia as well as vital
signs, particularly pulse and blood pressure, are
equally important determinations.
Therapeutic Management
Fundal Massage
- first step in controlling hemorrhage
- helps a woman to stimulate her uterine
contraction, promote uterine tone and
consistency, and minimize the risk for
hemorrhage
This procedure is usually effective in causing
contractions, and after a few seconds, the uterus
assumes its healthy, grapefruit-like feel.
 To prevent this more complications:

• Remain with the woman after massaging her

fundus
• Asses to be certain that her uterus is not relaxing
again
• Continue to assess carefully for the next 4hours
Administer a bolus or a dilute intravenous
infusion of oxytocin (Pitocin)

• to help uterus maintain tone

• the action is immediate
• has a short duration of action, approximately 1hour
• symptoms of anatomy can recur quickly if it is
administered only as a single dose
Drugs

• carboprost tromethamine (Hemabate) and a

prostaglandin F2a derivative, or methylergonovine
maleate (Methergine)
An ergot compound, both given intramuscularly, are second
possibilities
• Misoprostol (Cytotec)
A prostaglandin E1 analogue, may also be
administered rectally to decreased postpartum
hemorrhage
• Carboprost tromethaimine
May be repeated every 15 to 90 minutes up to 8
doses; methylergonovine maleate maybe repeated
every 2 to 4 hours up to 5 doses.
 
Additional measure to combat uterine atony
includes:

• Elevate the lower extremities

• Offer bedpan or assist the woman to the
bathroom at least every 4hours to be certain her
bladder is emptying
• Administer oxygen by face mask at a rate of
about 10 to 12 L/min
• Position her in supine (flat) to allow adequate
blood flow to her brain and kidneys
• Obtain vital signs frequently and assess them
ADDITIONAL MANAGEMENT
BIMANUAL COMPRESSION
• Bimanual uterine compression massage is
performed by placing one hand in the vagina and
pushing against the body of the uterus while the
other hand compresses the fundus from above
through the abdominal wall.
• bimanual compression of the uterus leads to
arrest in bleeding.
BLOOD REPLACEMENT
• Replace blood loss from postpartal hemorrage
- Tend to have longer recovery
• Iron theraphy
- Good homoglobin formation
• Precursor of postpartal infection
-scant or odorous lochia discharge
-temperature
Avoid
• Activity level
• Exertion
• Postpartal exercise
HYSTERECTOMY OR SUTURING
• is an operation to remove the uterus
• the womb and cervix are removed through an
incision that's made in the top of the vagina.
Special surgical instruments are inserted into the
vagina to detach the womb from the ligaments
that hold it in place. After the womb and cervix
have been removed, the incision will be sewn up.