Uterine atony Uterine atony is a loss of tone in the uterine musculature.

Normally, contraction of the uterine muscle compresses the vessels and reduces flow. This increases the likelihood of coagulation and prevents bleeds. Thus, lack of uterine muscle contraction can cause an acute hemorrhage. Clinically, 75 !"# of postpartum hemorrhages are due to uterine atony. Uterine atony$ failure of the myometrium to contract after delivery of the placenta% associated with e&cessive bleeding from the placental implantation site. 'efore (elivery )f you are at risk for uterine atony, your doctor or nurse should make the following preparations in case e&cessive bleeding occurs during or after delivery$ at least one large intravenous line should be established% medication to induce contractions of the uterus o&ytocin *+itocin,, methylergonovine *-ethergine,, and.or prostaglandins should be on hand% and appropriate nursing and anesthesia personnel should be available. )n addition, the blood bank should be notified of the possible need for a blood transfusion for certain high risk patients. /fter (elivery Uterine atony is diagnosed after delivery when there is e&cessive bleeding and a large, rela&ed uterus. The doctor first rules out other potential causes of the bleeding *tears in the vagina or cervi& and fragments of the placenta remaining in the uterus,% these problems should be resolved if they are present. )f the bleeding continues, the uterus may be stimulated to contract with use of massage and intravenous o&ytocin. -any studies show this techni0ue reduces postpartum hemorrhage and the need for blood transfusions. )f heavy bleeding from atony occurs despite the use of o&ytocin after delivery, then two additional medications may be used to help control hemorrhage$ -ethylergonovine, a strong vasoconstrictor derived from ergot, is in1ected into a muscle. )t is not given to patients with preeclampsia or a history of high blood pressure because it can cause high blood pressure. +rostaglandin 2 3 alpha *4emabate, is in1ected under the skin and also directly into the uterus. 2re0uent side effects include diarrhea and vomiting. )t can cause bronchial constriction and is usually avoided in patients with asthma. 5mergency surgery should be performed if atony persists despite these measures to control the bleeding. This may be accomplished by tying off the blood vessels that supply the uterus. )f successful, this procedure should not affect future pregnancies. )n a more involved procedure, the doctor uses & rays to guide a small catheter through blood vessels in the mother6s leg and into the blood vessels supplying the uterus. These blood vessels are then in1ected with gelatin sponge particles or spring coils to obstruct blood flow to the uterus. /lthough successful control of hemorrhage has been reported with this techni0ue, the e0uipment necessary to perform it may not be available in most emergency situations. )f bleeding persists in spite of all conservative measures to control it, a hysterectomy *removal of the uterus, may be necessary. Medical treatment. *a, )ntervenously fluids administered to increase fluid and blood volume. *b, 7&ytocin administration. *c, -ethergine.prostin may be administered to stimulate uterine contractions when o&ytocin is ineffective. *d, 'lood transfusion if the patient6s hematocrit drops too low and.or if she is symptomatic. Nursing interventions. *a, +alpate the fundus fre0uently to determine continued muscle tone. *b, -assage the fundus, if boggy, until firm *do not over massage, this fatigues the muscle,. *c, -onitor patient6s vital signs every 85 minutes until stable. *d, +revent bladder distention. 'ladder distention displaces the uterus and prevents effective uterine contractions. N9: (;$ (eficient fluid volume realted to postpartum hemmorhage /cute pain related to uterine cramping and perineal pain e&perienced <isk for ineffective tissue perfusion related to hemmorhage