Uterine atony

As Uterine atony is a weak contraction of the uterine muscles that can occur after the baby is born. The uterus then does not contract, which can result in life-threatening blood loss. It is the number one cause of mother death after childbirth.

What is uterine atonia?

In medicine, the uterus is the uterus. Atony means a relaxation of the muscles. The Uterine atony So describes a relaxation of the uterus, which can have life-threatening consequences for the mother. It can occur after the child is born if the uterine muscles do not contract or contract only incompletely. In this case, the uterus is soft and palpable from the outside, which is painful for the patient.

In the mother, the lack of contraction results in an above-average loss of blood, as the blood vessels cannot close in this way. An above-average amount of blood escapes through the permanent opening. Most of the time, the placenta has either only partially detached itself from the wall of the uterus, or not at all, which is known as a problem with dissolution. Other reasons are also proven.

causes

The most common cause of uterine atony is a failure of the placenta to detach from the uterine wall. The plaster cake is either not ejected at all or only in parts. The bleeding placenta or the rest of it remains in the uterus. This can be due to the placenta adhering to the wall of the uterus when it penetrates into the muscle layer.

If the placenta grows on an old scar that has arisen, for example, from the removal of a tumor or a previous caesarean section, it can result in only a partial solution. A spasm of the internal cervix can hold the placenta back. In this case, from a jammed plaster cake or a Placenta incarcerata spoken.

Another cause of the regression disorder can be an overstretching of the uterus. It is triggered by a larger than average child, multiple pregnancies or a lot of amniotic fluid. Many births are just as demanding on the uterus as deliveries by caesarean section. Birth forceps or a suction cup, which are used as aids during the birth of the child, can also overstretch the uterus.

A subsequent contraction is then made more difficult. If the birth takes a long time or if certain anesthetic gases are used, this can also affect the regression of the uterus. If so-called fibroids, i.e. benign tumors, are found in the muscle layer of the uterus before pregnancy or if there is an anatomical malformation of the uterus, they can result in atony.

Symptoms, ailments & signs

If the placenta is expelled about half an hour after birth, it must first be examined for completeness. If it is not, it can lead to gushing bleeding from the vagina. Often the mother's circulation collapses very quickly and a state of shock occurs.

Diagnosis & course of disease

If the placenta has not been expelled one hour after the birth of the child, action must be taken. The uterus in this case is soft and is usually located above the navel. If pressure is exerted on her, the patient finds it painful.

Complications

Uterine atony can cause serious complications. First of all, there is a risk of excessive bleeding when the child is born. This can cause circulatory problems, anemia and occasionally shock.

At the same time, the mother usually feels severe pain, which can make the birth process more difficult. In most cases, sedatives have to be administered, which are associated with health risks for the child and the mother. If the disease is severe, the child cannot be born through the normal birth route, but can be born by means of a caesarean section.

Although this is a routine procedure, complications can arise. There is a risk of damage to the internal organs, especially the bladder, intestines and uterus. It can also lead to infections and severe blood loss. After the operation, the affected women occasionally suffer from wound healing disorders or scar pain.

Sometimes the wound can open again and must then be closed again within a second intervention. In addition, the prescribed sedatives and pain relievers are always associated with certain side effects and interactions. Allergy sufferers may experience allergic shock.

When should you go to the doctor?

In the case of uterine atony, a doctor must usually be consulted. The disease itself is usually recognized by a doctor before the birth or directly during the birth and then treated. However, uterine atony cannot always be completely treated, and in some cases the child may die. The further course cannot generally be predicted. A doctor should be contacted if there is very heavy bleeding in the vaginal area immediately after the birth. The affected mother can also lose consciousness and must be treated by an emergency doctor.

Since uterine atony can also lead to death of the child, it is not uncommon for parents and relatives to be given psychological support. This can prevent psychological upsets or depression. Therefore, a psychologist should also be consulted after the child dies. If the uterine atony is treated successfully, regular examinations by a doctor are usually necessary even after the treatment.

Treatment & Therapy

If the placenta has not been completely rejected, the remains must be removed by scraping. This is usually done under anesthesia as it can be painful.If the placenta has been expelled completely and the uterus does not contract, medication is given first. They are called uterotonics and are contraction agents that contain agents such as oxytocin or methylergometrine to help support the muscles of the uterus.

Then the contents of the uterus are expressed so that the internal resistance is not so great and the muscles are also stimulated by movement. The mother's bladder is also emptied. Cold stimuli from 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. 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 exerts external pressure on the uterus. She erects the uterus and presses it against the inner fist and pubic bone. This supports the compression of the uterus, which causes the large vessels to close. The purpose of this is to keep the uterus from filling up with blood.

Massage of the uterus should complete the contraction of the uterus. However, it can lead to after-pains that can last up to two hours. If at this point all efforts are unsuccessful, the last resort to save the mother's life is to remove the uterus.

prevention

There is little that the patient can do to prevent uterine atony other than to attend regular checkups. During and after a caesarean birth, the attending physician can administer appropriate medication such as carbetocin or oxytocin to support the detachment of the placenta. It should also be borne in mind that a cesarean section 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. "Lighter" peripartal bleeding (bleeding volumes up to 1000 ml) can be stopped regularly with conservative therapy (manual uterine compression, uterine tamponade, uterine compression sutures or medication such as oxytocin). Follow-up care is then reduced to a maximum of two gynecological follow-up examinations (clinical or outpatient).

In addition to the visual check-up, the follow-up examinations usually also include an examination of the abdomen using ultrasound. In addition, further examinations are planned for midwifery care. Any complications that may arise as a late consequence can thus be identified and treated at an early stage. In the event of vaginal bleeding for no apparent reason, the person concerned must be presented to a doctor immediately.

"Heavy" peripartum bleeding (bleeding over 1000 milliliters) can only be treated surgically. The placenta is loosened manually. Abdominal pain is to be expected postoperatively. It is necessary to take strong painkillers. Antibiotic therapy may help the surgical wound to heal. In the event of an operation, the secondary task of aftercare is to guarantee that the newborn child is cared for.

The affected person will generally not be able to master these tasks due to the high blood loss during childbirth and the surgical procedure. After the clinical stay, further gynecological examinations using ultrasound are required for the follow-up control of the surgical wound. Psychotherapeutic counseling is also recommended for both parents.

You can do that yourself

A uterine atony is always treated by the responsible doctor or obstetrician. Depending on the course of the procedure, a Credé handle or the manual activation of contractions can be enough to adequately promote the contraction of the uterine muscles. If the course is severe, surgery may be necessary.

After the birth process, the complaints must be treated individually. In addition to general measures such as rest and relaxation, affected women must ensure careful intimate hygiene. If bleeding or other symptoms persist, inform the doctor.

If the uterine atony is severe, the patient's life is at risk. A birth trauma can occur, which has to be worked through. Affected women are best to speak to their gynecologist, who can put you in touch with a suitable therapist.

Since a birth trauma can disrupt the emotional connection between mother and child, the patients often need the support of a specialist or friends and acquaintances in the first few months in raising the child. Associations such as the midwifery network processing birth or shadow and light e. V. provide the women affected with further self-help measures and contact points.