Uterus atony
Description:
Uterus atony — the most frequent reason of puerperal bleeding. Usually the body of the womb is reduced right after the afterbirth birth, squeezing spiral arteries of a placental bed and preventing excess bleeding from them. Reduction of muscles of a uterus prevents bleeding from a placental bed in bigger a stepepena, than a blood coagulation. When expected are reduced does not occur, the arising atony of a uterus leads to puerperal bleeding.
Uterus atony reasons:
Though there is a certain risk group, sometimes the atony develops at the patients who are not belonging to such group. Detection of risk factors will allow the obstetric command to be prepared for the corresponding treatment of such patients. Because restretching of a uterus can lead to an atony, it is a lot of giving birth women, women with large fruits or a hydramnion should be carried to risk group. The general anesthesia, especially with use of the halogenated hydrocarbonates which relax a uterus long childbirth and rapid childbirth increase blood loss. Induction of childbirth or overdose of oxytocin, and also use of magnesium sulfate leads to strengthening of bleeding. Some researches showed that existence of an atony in the anamnesis and horioamnionit increase risk of emergence of an atony.
Uterus atony symptoms:
The atony of a uterus can be followed by severe outside bleeding, but at diagnosis is inexpedient to rely only on it. Blood can accumulate in a uterus, stretching it, hiding thereby up to 1000 ml of blood. The frequent palpation of an uterine fundus is necessary for definition of increase in the size of a uterus. The atony can lead to bleeding which remains reserved for an appreciable length of time, and in several hours there is massive, heavy outside bleeding. Surprisingly, but the majority of deaths arise not owing to plentiful bleeding, and because of inefficient treatment of weak bleeding. As OTsK during pregnancy increases, often puerperal bleedings can be diagnosed only after big blood loss. Attentive inspection of the patient, a uterus palpation, assessment of vaginal bleeding and vital indicators are obligatory at least within an hour after the delivery. This period has to be increased in the presence of any suspicions.
Treatment of an atony of a uterus:
Tactics of maintaining an atony of a uterus has to be both medical, and preventive. After normal childbirth, right after the afterbirth birth infusion of oxytocin, as a rule, begins (usually 20 PIECES of drug get divorced in 1 l of infusion solution which then is entered with a speed of 125 — 165 ml/h). Oxytocin promotes reduction of a body of the womb and reduces probability of its atony. It is applied in a divorced look as intravenous administration of strong solution of oxytocin can cause the expressed arterial hypotension. Medical actions at an atony of a uterus can be subdivided on handling, medicamentous and surgical. Massage of a uterus in itself usually causes reduction of a uterus, it it is also necessary to be used during preparation for other methods of treatment. Other manipulation which is seldom applied now — a hard tamponade of a cavity of the uterus is used by bandage as temporary means by preparation for the main treatment. For medicamentous therapy are used oxytocin, метергин (a metilergonovina a maleate) and various drugs of prostaglandins appointed separately or in a combination. Metergin — the powerful constrictor causing reduction of muscles of a uterus already in a few minutes. The drug is always administered intramusculary as bystry intravenous administration can cause dangerous hypertensia. F2a prostaglandin can be entered intramusculary or directly into thickness of a myometrium; it is possible to appoint E2 prostaglandin in vaginal suppositories. Both means lead to strong reduction of a uterus. Usually, as it is stated above, oxytocin is used for prevention of an atony of a uterus. If the uterus atony nevertheless arises, rate of administering of oxytocin has to be increased and in addition it is necessary to use метергин either prostaglandin, or both drugs at the same time. If use of massage of a uterus and uterotonichesky means does not lead to sufficient reduction of a uterus, it is necessary to resort to surgical methods of treatment. Bandaging of uterine or lower celiac arteries, the selection embolization of arteries and removal of a uterus are carried out. Sometimes these operations carry out according to vital indications. In hard cases of an atony of a uterus the choice of tactics of treatment has to be individual, taking into account degree of blood loss, the general condition of the patient, her plans of rather future child-bearing. In case of plentiful bleeding conditions for a massive transfusion have to be provided (a kateterizirovana a large vein) and donor blood is prepared (are defined its group accessory and compatibility tests are carried out).
