Description
Uterine atonic bleeding is massive bleeding during puerperium (the period from the end of the last stage of labor and the return of the uterus to its normal size after delivery: about 3-6 weeks in duration), and happens because of uterine contraction failure immediately after the placenta is delivered. It rarely occurs a day later.
Cause
# Excessive expansion of uterus: Uterine inflation from a multiple pregnancy, hydramnion, or a fetus with gigantism.
# Thin uterine muscle: Uterine contractions are weak because of thin uterine muscle.
# Fatigue of uterine muscle: Woman had a difficult labor from strong contractions or prolonged use of contraction drugs.
# Physical constitution: Thorough preparations must be made if there has been a history of excessive uterine bleeding in past pregnancies, anemia, or other debilitating conditions.
# Oxytocia: Uterine contractions can become weak after a speedy delivery
# General anesthesia: Certain general anesthetics weaken uterine contractions when used in excess.
Early Discovery
# The uterus fills with blood when uterine contractions are weak, and the blood stretches the uterine muscle, making contractions even weaker. Pressing on the uterus or an internal examination will detect the condition of contractions and blood in the uterus. Any blood in the uterus must be removed, because it can cause inflammation.
# Many women will not bear down or allow their abdomens to be touched after a natural birth or cesarean section because it hurts. But mothers should bear it, because uterine atonic bleeding is unmanageable after they are moved to a room.
# It is good to have somebody with the mother after delivery. The guardian should alert the medical staff of any abnormal symptoms such as severe bleeding, dizziness, and fainting.
Treatment
# Massage the uterus and inject uterine contraction drugs to control bleeding and recover contractility.
# If atonia uteri cannot be reversed, a peritoneotomy (abdominal section) can be performed to cut, tie, or momentarily press the arteria hypogastrica uterine artery and ovarian artery, which are big blood vessels supplying blood to the uterus.
# If the above methods are not successful, the difficult decision to remove a woman's womb must be made to save her life.
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