Hypotonic uterine bleeding

Description:

Hypotonic bleedings (the Greek hypo-+ tonos tension) — uterine bleedings which origin decrease in a tone of a myometrium is. Bleedings of this genesis can arise at department of a placenta or after its birth, and also at a delay in a cavity of the uterus of parts of fetal egg.

Reasons of hypotonic uterine bleeding:

The main reason for hypotonic bleeding — uterus hypotonia in the afterbirth period. Hypotonia is characterized by emergence of the rare spontaneously arising reductions at decrease in degree of a counteraction and retraction of muscle fibers of a myometrium. Extreme extent of decrease in a tone, up to its total absence, is designated as a uterus atony. Such states also lead to emergence of uterine bleeding on condition of partial or full department of a placenta. If the placenta is not separated from a uterus wall, bleeding is absent.

Extent of reaction of the neuromuscular device of a uterus on mechanical, physical and pharmacological irritants is, as a rule, not adequate to irritant force. It is possible to observe paradoxical reactions at which the strong or long irritant causes the small mechanical answer (reduction), and weak — higher response.

Uterus hypotonia is a consequence more often: a) insufficient stimulation of a uterus and systems of its regulation by hormones of a fetoplacental complex; b) braking of the separate links of a genetic code responsible for inclusion of normal sokratitelny function of a uterus in labor and provision of energy of this process; c) morphologically inferiority of a uterus (underdevelopment of its structures by the time of childbirth, hems, the inflammation centers, restretching, premature involution of intraorganic nervous structures of a myometrium). Hypotonic bleedings arise more often at women in labor at whom childbirth is complicated by weakness of pains, late toxicosis, restretching of a uterus and an endometritis, and also at operational methods of delivery.

Symptoms of hypotonic uterine bleeding:

Hypotonic bleedings in an afterbirth and early puerperal period have no constant character. Blood is emitted from a uterus in the small portions, is more often in the form of clots, especially at department of a placenta by Kyustner's method — Chukalova. The first portions of blood at incomplete and even full separation of a placenta from a wall of a uterus accumulate in her cavity and a vagina, without being allocated completely with force of reduction of a uterus. They can be removed from a uterus with expression if to it there are corresponding indications. Accumulation of blood in a uterus and a vagina quite often creates false idea of absence of bleeding therefore use of methods of department of a placenta and recovery of motor function of a uterus substantially is late.

Hypotonia of a uterus and as a result of it bleeding quite often disappear without any intervention at very careful maintaining the third period of childbirth. Rough manipulations on a uterus and disturbance of the guarding regime of the woman in labor can promote development of hypotonic bleeding.

Hypotonic bleedings in an early puerperal period can be continuation of bleedings of the afterbirth period or independently arise at the wrong, excessively active maintaining the third period of childbirth. These bleedings have wavy character and can not cause vigilances in the obstetrician conducting childbirth. As a rule, at inspection a uterus flabby, reduction waves rare, short. After expression of clots (accumulation they are worsened by recovery of motor function) a starting position of a uterus (in the lower part of an abdominal cavity) it is rather quickly recovered.

Extent of disturbance of motor function of a uterus can be specified at manual department of a placenta or introduction of a hand to her cavity for massage on a fist. At normal motor function of a uterus clearly force of reduction of a myometrium is felt as the hand entered into her cavity. At hypotonia weak reductions in response to mechanical irritations are noted; at an atony — reductions are absent, the uterus does not react to mechanical irritations.

Treatment of hypotonic uterine bleeding:

Treatment of hypotonic bleeding has to be directed to bystreyshy recovery of normal motor function of a uterus. At the hypotonic bleeding connected with a delay in a cavity of the uterus of parts of fetal egg urgent removal by their hand or by means of a big blunt curette is shown (watch the full set of knowledge the Scraping, a uterus). If pathological bleeding arose in the afterbirth period (blood loss of 400 milliliters and more), it is necessary to start immediately squeezing of a placenta, and at unsuccessfulness — manual department and its removal together with covers. It is not necessary to apply in the afterbirth period repeatedly techniques of outside squeezing of a placenta as they do not guarantee its removal, but in the meantime worsen sokratitelny function of a uterus and increase blood loss. Department and allocation of a placenta in most cases leads to recovery of reductions of a uterus and a stop of bleeding as its removal eliminates the blocking influence on motor function of a uterus of placental progesterone. The hand entered into a uterus should not be taken right after removal of a placenta. It is necessary to be convinced of recovery of normal reductions of a myometrium of a uterus. In the presence of hypotonia massage of a uterus on a fist is carried out. For this purpose the uterus is displaced by a fist of the entered kpereda hand, and the second hand make easy its strokings through covers of a front abdominal wall. Massage has to be carried out carefully. The rough mechanical irritation of a uterus can lead to its injury and emergence of extensive macrofocal hemorrhages which will sharply worsen it and so broken sokratitelny function. Along with it for stimulation of reduction of a uterus introduction of oxytocin or Pituitrinum is shown (5 — 10 PIECES subcutaneously or directly in a myometrium). The good effect is rendered by ergotamine, ergometrine, ergotal and others the Overdose of the specified drugs can cause paradoxical reaction of a myometrium of a uterus, that is worsen even more its sokratitelny function. Sometimes the good effect — strengthening of sokratitelny function of a uterus — is observed after the placement on a bubble stomach bottom with ice. Reflex reduction of a uterus at Hypotonic bleedings can also be caused irritation of receptor fields of a neck of uterus. For this purpose the tampon moistened with ether is entered into a back vault of the vagina on a packer. In a complex with other actions sometimes the good effect renders a cross seam on a neck of uterus across Lositskaya. For this purpose use a thick catgut. The seam is removed in 12 — 20 hours. Also various methods of electrostimulation of a uterus are offered. M. I. Medvedev was used for stimulation alternating current of 5 — 10 volts, and by Z. A. Chiladze — the category of a direct current of 4000 volts. At the proceeding bleeding use of a method of Baksheev at which by means of fenestrated nippers (3 — 4 from each party) the klemmirovaniye of side departments of a uterus is made is shown. One branch of a clip is entered into a cavity of the uterus, and another into the side arch on area of a vascular bundle. At a prelum of vessels decreases, and sometimes Bleeding completely stops. The good effect is reached also at a prelum of uterine vessels by the clips imposed on area of a parametrium through side vaults of the vagina (Genkel's method — Tikanadze). I. E. Tikanadze suggested to replace nippers to Myuza with intestinal clips which put on rubber tubules that almost completely excludes a possibility of damage of tissues of vagina, vessels, an ureter and a bladder.

Prevention:

Prevention — carrying out a complex of actions for improvement of pregnant women, the prevention of an abortion injury and effective treatment of inflammatory processes of a uterus, a balanced diet of pregnant women, use of actions for the prevention of weakness of patrimonial activity, and at its development — effective treatment. For the purpose of the prevention of development Hypotonic bleedings at women in labor with weak patrimonial activity and other obstetric pathology (a hydramnion, a multiple pregnancy, a large fruit and so on) at the end of the second period of childbirth intravenously kapelno enter 1 — 2 PIECE of oxytocin on физиол. solution or 5% glucose solution. For strengthening of power processes in muscular tissue sick appoint oxygen, intravenous administration of 40% of solution of glucose, 10% of solution of a gluconate of calcium and 1% of solution of Sygethinum.