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Understanding Utonic Atonia in Pregnant Women

Uterine atony is a condition in women where the uterus fails to contract after childbirth. This condition can result in postpartum bleeding which can be life threatening. After delivery, to prevent bleeding, contractions generally occur to help compress the blood vessels attached to the placenta. The muscles of the uterus will also contract and tighten to expel the placenta. If the uterine muscle is not strong enough to contract, bleeding will occur. This situation requires emergency treatment to stop the bleeding and replace lost blood.

Get to know the Atonia Uteri and the Risks

Uterine atony or uterine failure to contract is the main cause of postpartum bleeding. While postpartum hemorrhage is one of the main factors causing maternal death. Uterine atony can trigger postpartum hemorrhage with the characteristics of increased heart rate, decreased blood pressure, heavy bleeding, and pain in the back. Cases of postpartum hemorrhage are still high in developing countries with causes that cannot be known with certainty. However, there are several factors that are thought to interfere with the ability of the uterine muscles to contract, namely:
  • A very fast delivery or a very long delivery.
  • Induction labor.
  • Use of general anesthesia, oxytocin, or other drugs in labor.
  • The uterus is too stretched due to the size of the pregnancy.
Although it can be experienced by anyone, some women are more at risk of uterine atony, especially those who are over the age of 35, give birth to twins, have babies larger than average (macrosomia), are obese, have had several deliveries, a history of delayed labor, and having too much amniotic fluid. In addition to fatigue, anemia, and orthostatic hypotension, uterine atony can also cause shock complications due to lack of blood volume, which can be life threatening.

Anticipation and Management of Uterine Atonia

Uterine atony is more difficult to predict than other causes of bleeding such as abnormalities in the placenta, and can only be detected soon after delivery. Atonia uteri is a serious condition that needs to be treated and evaluated rigorously in the hospital. To seek safe delivery, pregnant women need to get regular periodic pregnancy checks and deliver with the help of skilled medical personnel. When giving birth, the doctor or midwife will conduct an examination to determine whether there is still a placenta left in the uterus and evaluate the presence or absence of other causes of bleeding that need to be anticipated. Steps to handle uterine atony that can be done include:
  • Infusion and blood transfusion as soon as possible to stop bleeding and replace lost blood, and close observation by medical personnel.
  • Provision of stimulants for uterine contractions such as oxytocin, prostaglandins, and methylergonovine when labor enters the placental removal phase. Provision of stimulants for uterine contractions can be followed by uterine massage.
  • If other steps do not produce results, the doctor can embolize the uterine blood vessels by injecting certain substances to block blood flow to the uterus, or perform operations to bind the uterus blood vessels.
  • If all efforts have been made but still cannot overcome bleeding due to uterine atony, it is necessary to have a surgical removal of the uterus.
Uterine atony cannot always be prevented. If you experience one or more of the risk factors above, then you need to immediately consult your pregnancy to your doctor. Taking pregnancy supplements regularly can also help prevent anemia and complications from uterine atony, which is postpartum bleeding.