Becoming a mother is one of the most beautiful and responsible experiences in life. However, with this joy, sometimes unexpected health problems can arise. Today, we are going to talk about a serious but treatable condition that some mothers face after giving birth. This is called uterine atony, or in medical terms , uterine atony .
What is Uterine Atony? Simply put...
Simply put, Uterine Atony is when your uterus doesn't contract properly or tighten properly after childbirth. Normally, after the baby is born, the uterus contracts well and controls bleeding after the placenta has been delivered. However, in this condition, the uterine muscles don't work properly, meaning they are loose and not as tight. This is very dangerous because it can cause heavy bleeding that can be life-threatening .
Think about it, when your baby is growing inside the uterus during pregnancy, the baby gets all the blood, oxygen, and nutrition it needs through the placenta. There are many blood vessels that supply blood to this placenta. After the baby is born, the uterus contracts to expel the placenta. When it contracts, those blood vessels tighten and stop bleeding. So, if the uterus does not contract properly, that is, if there is (uterine atony), those blood vessels start bleeding continuously. This is what we call postpartum hemorrhage .
This condition (uterine atony) can occur after a miscarriage or other surgery involving the uterus. It can occur during normal delivery as well as during a cesarean section. Although this condition occurs in about 2% of all births, it does not always cause excessive bleeding. However, this is a condition that requires immediate medical attention. If treated promptly, a full recovery is possible.
What happens if the uterus doesn't contract after having a baby?
If the uterine muscles don't contract properly after delivery, you're at high risk of bleeding. As we mentioned earlier, after delivery, the placenta needs to separate from the uterine wall. This opens up the blood vessels there. The contractions of the uterus tighten those blood vessels and stop the bleeding. So, if the muscles don't contract properly, the bleeding will continue. This is a medical emergency, as it can be life-threatening.
What factors increase the risk of this condition?
There are several risk factors for uterine atony. These factors can interfere with your uterus contracting after childbirth:
- If this is your first baby , or if you have more than five children .
- If you are expecting twins, triplets, or more .
- If your baby is larger than normal (doctors call this Fetal Macrosomia) .
- If you are over 35 years old .
- If you have too much amniotic fluid (the water around the baby) (this is called polyhydramnios) .
- If you are obese .
- If you have uterine fibroids .
Also, doctors believe that if these things happen during labor, the uterus may not contract after delivery:
- If you had very long labor pains , or if you had a very quick delivery .
- If you had a difficult childbirth .
- If your labor was induced .
- If you have had a condition called Chorioamnionitis (an infection of the membranes surrounding the baby).
- If you had been given general anesthesia .
- If you have an enlarged uterus .
Important: If you have more than two of these risk factors, you are at higher risk of developing uterine atony. Doctors identify those at risk early and make necessary preparations before delivery, so that they can be implemented quickly.
Why is this happening? What are the reasons?
Uterine atony occurs when the muscles of the uterus do not respond properly to the hormone (oxytocin) that your body produces to stimulate uterine contractions before and during labor. Simply put, it is as if the uterus "does not listen."
What are the symptoms of this?
The biggest and most important sign of uterine atony is persistent or excessive bleeding from the uterus . Most of the time, your doctor will detect this condition right after you deliver your baby. In addition, after giving birth, your uterus may become loose, weak, and not firm.
Other symptoms are:
- Low blood pressure .
- Fast Heart Rate .
- Feeling dizzy or faint .
- Appearing pale .
- Loss of consciousness .
- Inability to urinate .
- Pain, especially back pain .
How do doctors recognize this?
Our doctors are trained to diagnose and treat Uterine Atony quickly. This is usually diagnosed by manually examining the size and softness of your uterus after childbirth. The doctor will place one hand on your belly and insert the fingers of the other hand into your vagina to examine your uterus. Some doctors will also weigh the pads or gauze used to absorb the blood to estimate how much blood you have lost.
If you have uterine atony, your uterus is large, soft, and weak. In a normal delivery, the uterus should contract (harden or stiffen) and begin to shrink after the baby is born.
Since uterine atony is the leading cause of heavy bleeding after childbirth, your doctor will also check for the following:
- Are there any tears in your cervix, vagina, or uterus ?
- Whether parts of the placenta (Retained Placental Tissue) are stuck inside the uterus.
Your doctor will continue to monitor your blood pressure and heart rate for changes. They may also do blood tests to check your red blood cell count and blood clotting factor.
What are the treatments?
Uterine atony is an emergency, so it requires immediate action from your medical team. The main goal of treatment is to stop the bleeding as quickly as possible and replace lost blood or fluids . Even after the bleeding is controlled, you may need to have a blood transfusion or IV fluids to replace what has been lost.
Your obstetrician-gynecologist will usually start treatment by massaging the uterus to help it contract more forcefully. Depending on the severity of the condition, this may even help to cure uterine atony.
In addition to uterine massage after childbirth, your doctor may use several medications to help your uterus contract. These medications include:
- (Oxytocin) (brand name Pitocin®)
- (Methylergonovine) (brand name Methergine®)
- Prostaglandins , for example 15-methyl-PGF2 (Hemabate®), misoprostol (Cytotec®) or dinoprostone .
- Types of Ergot Alkaloids , for example (Ergometrine) .
Applying pressure to the uterine walls (Tamponade Techniques)
Your doctor may need to apply more pressure to your uterus to limit the amount of bleeding. These methods include packing the uterus with gauze or inflating a balloon inside the uterus. With these methods, the doctor applies direct pressure to the uterine wall to stop the bleeding.
Treatment by surgery
If all other methods fail to stop the bleeding, surgery may be necessary. Surgical procedures used to treat uterine atony include:
- (Uterine Curettage): In this, the doctor scrapes and removes any blood or placenta fragments that are trapped inside the uterus (similar to a D&C).
- Uterine Artery Ligation: A procedure that ties off the blood vessels that supply blood to the uterus.
- (Uterine Artery Embolization): A procedure that uses small, sand-like particles to stop bleeding in the uterus.
- Hysterectomy: As a last resort, if all else fails, removal of the uterus.
What other problems can this cause?
Uterine atony can cause complications such as:
- Anemia - that means lack of blood.
- Feeling very tired or overworked .
- Feeling dizzy or faint due to low blood pressure.
- Increased risk of bleeding in future pregnancies.
Can this be prevented?
Most of the time, uterine atony cannot be prevented. But if you are at risk, your doctor can take steps to prepare for heavy bleeding. For example, having extra helpers or equipment in the delivery room, or having you deliver your baby at a different hospital, can help. You can take steps to have a healthy pregnancy. This includes taking prenatal vitamins , keeping your prenatal appointments , and maintaining a healthy weight during pregnancy.
If you have had heavy bleeding during a previous delivery, please be sure to inform your obstetrician and gynecologist about it.
Could this happen again?
Yes, it is possible to have uterine atony more than once. If you have had it before, you are at higher risk of having it again.
Finally, I have to tell you... (Take-Home Message)
Uterine atony is a serious complication that can occur after childbirth. If you have this condition, your medical team will need to treat you quickly to prevent excessive bleeding. Talk to your doctor about uterine atony and whether you are at risk for it. Being aware of the risks ahead of time will help you be prepared for emergency treatment if necessary. Remember, being aware of these things is not a cause for fear, but rather an opportunity to get help quickly if needed. You are not alone, and doctors are always ready to help you.
` Uterine Contraction, Uterine Atony, Postpartum Bleeding, Childbirth, Uterus, Women's Health, Placenta
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