What is Uterine Atony? How Can it Be Treated?

Giving birth is a beautiful yet painful experience for mothers. There is no experience that can compare to it. It can also be cited as proof why women have a greater tolerance for pain than men do. There are all kinds of muscles at work as women bring a new life into the world. Unfortunately, things do not always go according to plan during the process. Uterine atony is one of those sad instances.

What is uterine atony?

Uterine atony is the failure of the uterus to contract following delivery. It is the most common cause of the obstetric emergency that is postpartum hemorrhage. Endogenous oxytocin is released during delivery. When the oxytocin level is not enough or if there is an inadequate contraction of the uterine muscles (myometrium), then it results in a floppy or atonic uterus.

Delivery of the placenta leaves disrupted spiral arteries open. To control the bleeding, uterine contraction is needed to mechanically squeeze them into a hemostatic state. Uterine atony is one of the primary causes of maternal mortality or pregnancy-related death.

Risk factors for uterine atony

Certain women have  higher risk  for having uterine atony-related postpartum hemorrhage. These women have had prior uterine surgery, current multiple gestations,  grand multiparity, and prior postpartum hemorrhage.

Other factors are women with large fibroids, macrosomia, body mass index greater than 40, and anemia. Chorioamnionitis, prolonged second stage of labor, exposure to oxytocin longer than 24 hours, and magnesium sulfate administration can also affect the tone of the uterus.

Treatment and management of uterine atony

There are several treatments that have proven effective in treating postpartum bleeding from uterine atony. Preparing for possible blood loss is needed. Women who are at high risk should  have her blood properly typed and cross-matched during labor.

Experts advise active management of the third stage of labor. This includes uterine massage with concomitant sustained low-level traction on the umbilical cord. Simultaneous oxytocin infusion is helpful, although it is okay to defer it to after delivery of the placenta.

Massaging the uterus has proven effective along with ensuring a completely delivered placenta. Medications for postpartum hemorrhage secondary to uterine atony include oxytocin, methylergonovine, 15-methyl-PGF2-alpha, misoprostol, and dinoprostone.

Surgical Treatments available

Should medication fail with continued excess bleeding, doctors may recommend surgery. Obstetricians may use conservative ways to effect uterine contraction including bimanual compression of the uterus and placing multiple compressive sutures.

In 1997, Christopher B-Lynch devised an innovative technique to treat uterine atony. Doctors have used this method successfully around the world. Called the “B-Lynch suture,” it can be applied easily and rapidly.

The B-Lynch suture is a continuous suture to envelope and mechanically compress the uterus. This is an attempt to avoid a hysterectomy. 

Two tamponade techniques have been cited for effectiveness. One involves uterine packing with gauze while another involves inserting a Bakri balloon.

Other surgical management techniques are available. Namely, uterine curettage for retained products, uterine artery ligation, hypogastric artery ligation, and finally, if all else fails, a hysterectomy.

Key takeaways

As beautiful as the process of childbirth is, there are unexpected things that may happen. Uterine atony is one of these scenarios. This occurs when the uterus fails to contract upon completion of delivery.

Certain women are more likely to have uterine atony related to postpartum hemorrhage. Medications are continuously being developed and discovered for treating these kinds of conditions. A few surgical techniques have proved to be successful when these medications are not enough.

For more on pregnancy complications, click here.

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