Uterine atony is a contraction weakness of the uterine muscles that can occur after the baby is born. The uterus then fails to contract, which can cause life-threatening blood loss. It is the most common cause of maternal death after childbirth.
What is uterine atony?
Uterus is the medical term for the uterus. Atony means a slackening of muscles. Uterine atony, then, refers to a slackening of the uterus that 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 incompletely. In this case, the uterus is soft and palpable from the outside, which is painful for the patient. The mother suffers above-average blood loss due to the lack of contraction, as the blood vessels cannot close in this way. An above-average amount of blood leaks through the permanent opening. In most cases, the placenta has either separated from the wall of the uterus only in parts or not at all, which is called a solution disorder. Other causes have also been demonstrated.
Causes
The most common cause of uterine atony is a detachment disorder of the placenta from the uterine wall. In this case, the placenta is either not expelled at all or is expelled only in pieces. The bleeding placenta or its remaining remnants remain in the uterus. This may be due to adhesion of the placenta to the wall of the uterus if it penetrates to the muscular layer. If the placenta grows on an old scar, for example, caused by removal of a tumor or a previous cesarean delivery, it may result in only partial resolution. A spasm of the internal cervix may retain the placenta. In this case, it is referred to as a trapped placenta or placenta incarcerata. Another cause of regression may be overdistension of the uterus. It is triggered by a larger-than-average child, multiple pregnancies or a lot of amniotic fluid. Many births stress the uterus, as do deliveries by cesarean section. Also, forceps or a suction cup used as an aid in delivering the baby can overstretch the uterus. Subsequent contraction is subsequently more difficult. If the birth lasts for a very long time or if certain anesthetic gases are used, this can also affect the uterus’ ability to contract. If so-called fibroids, i.e. benign tumors, are found in the muscular layer of the uterus before pregnancy or if there is an anatomical malformation of the uterus, they can result in atony.
Symptoms, complaints, and signs
If the placenta is expelled about half an hour after birth, the first thing to do is to examine it for completeness. If it is not, there may be gushing bleeding from the vagina. Often the mother’s circulation collapses quite quickly and a state of shock occurs.
Diagnosis and course of the disease
If the placenta has not been expelled one hour after the birth of the baby, action must be taken. In this case, the uterus is soft and is usually located above the navel. If pressure is applied to it, the patient feels this as painful.
Complications
Uterine atony can cause serious complications in some circumstances. First, there is a risk of heavy bleeding when the baby is born. This can cause circulatory problems, anemia, and occasionally shock. Accompanying this, the mother usually feels severe pain, which can complicate the birth process. In most cases, sedatives must be administered, which are associated with health risks for the child and the mother. In the case of a severe course, the child may not be born through the normal birth route, but may be delivered by means of a cesarean section. Although this is a routine procedure, complications can still occur. For example, there is a risk of injury to the internal organs, especially the bladder, intestines and uterus. In addition, infections and severe blood loss can occur. After the operation, affected women occasionally suffer from wound healing disorders or scar pain. Sometimes the wound can reopen and must then be closed again within a second operation.Accompanying this, the prescribed sedatives and painkillers are always associated with certain side effects and interactions. Allergy sufferers may experience allergic shock.
When should you see a doctor?
In the case of uterine atony, as a rule, a doctor must always be consulted. In this case, the disease itself is usually detected 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 generally be predicted. A doctor should be contacted if there is very heavy bleeding in the vaginal area immediately after birth. The affected mother may also lose consciousness and must be treated by an emergency physician. Since uterine atony can also lead to the death of the child, it is not uncommon for psychological care to be required for the parents and relatives. This can prevent psychological upset or depression. Therefore, a psychologist should also be consulted after the death of the child. If uterine atony is successfully treated, regular examinations by a physician are usually still necessary after treatment.
Treatment and therapy
If the placenta has been incompletely rejected, the remains must be removed by scraping. This is usually done under anesthesia, as it can be painful. If the placenta has been completely expelled and the uterus still does not contract, medications are first administered. They are called uterotonics and are contraceptives containing active ingredients such as oxytocin or methylergometrine to help the muscles of the uterus. The contents of the uterus are then expressed so that internal resistance is not so great and the muscles are also stimulated by movement. The mother’s urinary bladder is also emptied. Cold stimuli through the application of cooling elements also support the contracting movement of the muscles. The Credé handle applied from the outside supports the detachment of the placenta. If this does not lead to the desired success, the Hamilton handle is used. Here, the whole hand is inserted into the woman’s vagina. It is clenched into a fist with the knuckles facing the front wall of the uterus. The other hand also applies pressure to the uterus from the outside. It straightens the uterus and presses it against the inner fist as well as the pubic bone. In this way, the compression of the uterus is supported, which results in the closure of the great vessels. In this way, the uterus should be prevented from filling up with blood. Massaging the uterus should bring the contraction of the uterus to a close. However, it can lead to afterpains that can last up to two hours. At this point, if all efforts have been unsuccessful, the last resort to save the mother’s life is removal of the uterus.
Prevention
There is not much the patient herself can do to prevent uterine atony, except to go for regular checkups. During and after a cesarean delivery, the attending physician can administer appropriate medications, such as carbetocin or even oxytocin, to help the placenta detach. It should also be remembered that elective cesarean delivery is not recommended, as this type of birth promotes uterine atony.
Aftercare
In uterine atony, the extent of follow-up care is determined by the severity of the bleeding. “Mild” peripartum hemorrhage (hemorrhage volumes up to 1000 ml) can be stopped regularly using conservative therapy (manual uterine compression, uterine tamponade, uterine compression sutures, or medications such as oxytocin). Follow-up care is then reduced to a maximum of two gynecological follow-up examinations (clinical or outpatient). In addition to visual follow-up, the follow-up examinations usually include an examination of the abdomen using ultrasound. In addition, further examinations are scheduled during midwifery care. Any complications that may arise as a late consequence can thus be detected and treated at an early stage. In the event of vaginal bleeding with no apparent cause, the affected woman should be presented to a physician immediately. “Severe” peripartum bleeding (bleeding in excess of 1000 milliliters) can generally only be treated surgically. The placenta is detached manually. Postoperatively, pain in the abdomen is to be expected.The use of strong painkillers is necessary. Antibiotic therapy can support the healing of the surgical wound if necessary. In the case of surgery, the secondary task of aftercare is to guarantee the care and support of the newborn child. The affected person will basically not be able to cope with these tasks due to the high blood loss during birth and the surgical procedure. After the clinical stay, further gynecological examinations by ultrasound are necessary for the follow-up of the surgical wound. In addition, psychotherapeutic counseling is recommended for both parents.
What you can do yourself
Uterine atony is always treated by the responsible physician or obstetrician. Depending on the course of the procedure, a Credé handgrip or manual activation of labor may already be enough to sufficiently promote contraction of the uterine muscles. If the course is severe, surgical intervention may be necessary. After the birth process, the discomfort 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 complaints continue to occur, the doctor must be informed. In the event of a severe course of uterine atony, the patient’s life is in danger. Birth trauma may occur, which must be worked through. Affected women are best advised to talk to their gynecologist, who can put them 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 professional or friends and acquaintances during the first months of raising the child. Associations such as the midwives’ network Verarbeitung Geburt or Schatten und Licht e. V. provide affected women with further self-help measures and points of contact.