Uterine Atony

Uterine Atony: Prevention, Diagnoses, And Treatment

Uterine atony or the atony to the uterus is a serious condition that will happen after the childbirth. Uterine atony is a life-threatening condition and it also leads to maternal death. If any women experience this condition then she will need immediate medical treatments.

If you want to know about the uterine atony, subinvolution, and fundal massage. Then keep reading this blog to know. 

What Is Uterine Atony?

Uterine Atony

Atony of the uterus is known as the uterine atony it is a serious health condition that can occur after childbirth. In medical terms, uterine atony means that loss of tone in the uterine of musculature. It can occur when the uterus fails to contract after the delivery of the baby, which can lead to a life-threatening condition which is known as a postpartum hemorrhage.

After the delivery of the baby, the uterus muscles normally tighten, and the uterus contracts for delivering the placenta. This compression will help to compress the blood vessels in the body which attached to the placenta.

This compression will also help to prevent the bleeding in the body after childbirth. Thereby it can increase the coagulation and also prevents postpartum hemorrhage, which can cause maternal mortality and morbidity worldwide.

But if the muscle of the uterus did not contrast strongly enough, then the blood vessels are bleed freely from the uterus. This condition can lead to excessive bleeding or hemorrhage.

If any women have atony of the uterus, then she will need immediate treatment to stop the bleeding and to replace the loss of the blood vessels. Uterine atony is one of the most common cause which can lead to postpartum hemorrhage. According to the studies, more than 80% of cases of postpartum hemorrhage are reported which are caused by the uterine atony.

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Some Other Factors Of Uterine Atony Are:

The twin’s pregnancy is one of the risk factors that develop uterine atony. Some other factors of the uterine atony are labor abnormalities, previous history of postpartum hemorrhage, and overdistension of the uterus. The most common and first step that peoples are using to treating the uterine atony is an application of the nonsurgical therapies which includes manual compression, uterotonics, and uterine massage.

If the uterine atony does not treat by the nonsurgical therapy then, there are also some surgical options for the uterine atony treatments are available. These surgical options are balloon tamponade, uterine artery, or an internal iliac artery ligation, uterine compression sutures, balloon tamponade, hysterectomy, or the uterine artery embolization.

According to the publication of 1997 the B-Lynch the compression suture. The various techniques of uterine compression sutures that have been introduced and also used worldwide as a  safe alternative as compared to the other surgical methods. So the uterine compression suture technique is one of the simple and effective for the urinary atony treatment.

It also preserves the anatomical integrity of the uterus, thus it will occur the future fertility in many women.

According to the review of one article, the rates of the subsequent pregnancy in the patients who had uterine compression sutures were 11 to 75% with an average of 32%.

In the past two decades according to the numbers of demonstrated merits and the efficacy of the uterine compression sutures to treat the Uterine atony. Most of the studies of the decades are based on the sample of who have one baby delivery or a mixed sample of the single and twin baby developers.

The high risk of uterine atony is a twins pregnancy, but no study or evidence proves the twin’s pregnancy is the only reason for uterine atony. 

Uterine Atony Signs And Symptoms?

One of the most common and foremost signs and the symptoms of uterine atony is the uterus will remain relaxed without any tension after the baby’s birth. Uterine atony is the primary reason for postpartum hemorrhage.

Postpartum hemorrhage defines as a loss of more than 500 milliliters of blood after the delivery of the placenta. About 1 to 15 percent of women have a postpartum hemorrhage, which is more likely with a cesarean birth.

The Hemorrhage occurs after reliving the average amount of blood loss, after the single baby delivery from the vaginal. The average amount of blood loss for a cesarean birth is approximately 1000ml.

In most women, postpartum hemorrhage occurs just after the baby’s delivery, but it can also occur later as well.  The most common symptoms of uterine atony are postpartum, but every woman may experience different symptoms. Here are the most common symptoms: 

  • Uncontrolled bleeding after giving birth to the baby
  • Decreased blood Pressure 
  • The decrease in the red blood cell count. 
  • Increased heart rate after baby delivery 
  • Pain and swelling in the vagina and also the nearby area when bleeding from a hematoma. 
  • Backache 

Some symptoms and signs of hemorrhage look like other health conditions. So consult with your healthcare provider or doctors for a diagnosis. 

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What Is the Cause Of Atony Uterine?

delivery baby with mummy

Once the baby delivers through the uterus, Then the uterine contracts normally after the baby’s birth and also expel the placenta. After the placenta delivers, then these contractions can help to compress the bleeding vessels in those areas where the placenta is attached.

When the uterus is not contracting strongly enough this will be known as the uterine atony. When these blood vessels are bleed freely and the hemorrhage occurs. These are the common cause of postpartum hemorrhage.

When the small pieces of the placenta are always attached then the bleeding is more likely to occur. Some women have a greater risk of postpartum hemorrhage than other conditions. Here is some cause of atony uterine. 

  • Placental abruption. Placenta detachment from the uterus.
  • Placenta previa. 
  • The overdistended uterus. Enlargement of the uterus due too the amniotic fluid or the baby is larger than the size. When the baby’s birth weight is over 4000 grams. 
  • Multiple pregnancies
  • High blood pressure of pregnancy
  • Having many births in the past 
  • Prolonged labor
  • Obesity 
  • infections
  • Using medications to induce labor
  • Using Medication to stop Contractions
  • Vacuum-assisted delivery or using forceps
  • Using General anesthesia 
  • Tear in the vaginal or the cervix tissues
  • A tear of the uterine blood vessels
  • Having bleeding into the conceal tissues is the space in the pelvis that will develop the hematoma. it will usually develop in the vaginal or vulva areas. 
  • Blood clotting disorders 
  • Placenta accreta
  • Placenta percreta 

If you have a higher risk of uterine atony then you may feel the following causes:

  • Delivering multiples babies such as twins or the triplets
  • Baby is much larger than the average, known as fetal macrosomia 
  • If the mother is older than the 35 years of age 
  • If you are obese 
  • Having too much amniotic fluid, which known as polyhydramnios 
  • If you have many prior births
  • If you are obese

The uterine atony also occurs in those women who don’t have any risk factors. 

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Diagnosing Uterine Atony 

Usually, uterine atony diagnose when the uterus is getting soft, and relaxe after the baby’s birth. And there is also no excessive bleeding after giving birth.

The doctor is estimating the loss of blood from the mother’s body by counting their number of saturate padas and weighing the sponges that the mother is used to absorb the blood after the delivery. 

The doctor also does some physical examinations to rule out, because these examinations can help to rule out the other causes of bleeding. These examinations include making sure that there are no tears in the cervix or the vegina.

Also, there are no pieces of the placenta that are still in the uterus. The doctor is also monitoring and examine these following things. 

  • The doctor will notice the pulse rate of the mother
  • They will also the blood pressure level of mother after and during the delivery 
  • They will count red blood cells 
  • Also, monitor the clotting factors in the blood. 

Uterine Atony Treatment 


The treatment will depend on the diagnosis and cause. But the treatment first step is stopping the bleeding and replacing the blood that was lost after the baby’s birth. So the doctor will give them IV fluids, blood, and blood products as soon as possible. Here are some atony treatments 

  • Uterus massage: In this doctor will be placing there one hand on the women’s lower abdominal or in the vagina and also pushing them against the uterus while the doctor’s other hand will compress the uterus through the abdominal wall.
  • Giving Uterotonic drugs such as prostaglandins, oxytocin, and methylergonovine. 
  • Blood Transfusion 

If the mother is in severe health condition then the doctor will give them these treatments:

  • Tie off the blood vessel by surgery
  • Uterine Artery Embolization. It involves injecting the small particles into the uterine and the artery to block the blood flow into the uterus. 
  • If all the treatments are getting fail, then the doctor will give the hysterectomy. 

What Is Subinvolution Of Uterus

Subinvolution of the uterus is a medical condition in which the uterus does not return to its normal size after giving birth.

The cause of this uterine subinvolution is inherited coagulation disorders, inflammation, and consumptive coagulopathy, and the retained products of the conceptions.

The others are of rare occurrences, such as the vessel subinvolution of the placental implantation site and trauma or the uterine artery pseudonymous.

Outlook For the uterine atony

Postpartum hemorrhage is a serious health issue that causes death birth in countries, who have limited healthcare facilities. It will also occur due to the lack of trained healthcare providers. The death rate from the postpartum hemorrhage is less common in the united states.

The death occurs by the postpartum in less than 1 percent of cases. Well, every woman is different so a certain health-relating condition may increase the risk of hemorrhage. According to the ACOG reports, one of the most common causes of postpartum hemorrhage is uterine atony and also the lacerations of the vagina and cervix.

Some other cause of the hemorrhage retains placental fragments, The uterine rupture, and the placenta accreta. Some time postpartum will cause later after childbirth. It will also cause 24 hours to six weeks after baby birth. So the causes of postpartum are infection, placental site subinvolution, hereditary coagulopathy, and retained placental fragments.

A woman’s risk of dying from the condition increases, if there are delays in transport to a hospital, in making the diagnosis. But if the woman is not receiving the recommended treatment, then it will cause death risks. If the women are getting the proper treatment then the complications are rare. 

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Uterine Atony Risk Factors 

delivery baby with family

The risk factors of the uterine atony are included the overdistention secondary to the hydramnios, the use of the oxytocin, multiple gestations, fetal macrosomia, and the rapid or the prolonged accreta. The uterine atony occurs on one of 2500 deliveries are the previous puerperal, high parity, and the placenta previa.

According to the reports, the risks of the placenta accreta is 25 percent or higher in the presence of the placenta previa. It also occurs in one of the more previous cesarean delivery of the scars. According to the report of states, uterine atony it occurs one of the 2000 deliveries.

The previous uterine surgery, transfused cesarean delivery, or the particularly deep myomectomy are the significant risks of the factors for the uterine ruptures and also the hemorrhage. Some other risks of factors of the uterine atony are multiple gestations, obstructed labor, high parity, and abnormal fetal lie. 

The risk factors of the hemorrhage and the atony uterine are at the time of the cesarean delivery which includes preeclampsia. It also occurs due to the due active labor, a history of the previous hemorrhage, obesity. Also the uses of general anesthesia and intra-amniotic infections.  

According to Blood Transfusion In Clinical Practice, uterine atony is causing up to 90 percent of postpartum hemorrhage cases. Hemorrhage usually occurs after the placenta delivers. But some factors may cause the risk factors of uterine atony. These some other risk factors are:

  • Anemia 
  • Fatigue
  • Increased risk of hemorrhage in a later pregnancy
  • Fatigue and tiredness 
  • Orthostatic hypotension, which causes dizziness or a lightheadedness four to the low blood pressures. 
  • Having anemia or fatigue after the baby’s birth will increase the chances of postpartum depression in mothers. One of the serious complications of uterine atony is hemorrhagic shock, this health condition will become sometimes life-threatening. 

Postpartum Hemorrhage Nursing Diagnosis 

According to the complete medical history and physical examination, the diagnosis is usually based on the symptoms. The laboratory tests are often helpful for diagnosis. Some tests that are using to diagnose hemorrhage are:

  • Estimation of the blood vessels 
  • Pulse rate and the blood pressure measurement 
  • Clotting factors in the blood 

History And The Physical 

At prenatal examination and history of the factor, discernment is key to optimal risk management. The identification of the risks allows from planning and the availability of resources that needs, such as equipment, medication, personnel, adequate intravenous access.

The American college of obstetricians is recommending that women are identified by the prepatellar as a high risk of postpartum hemorrhage based on the presence of placenta accreta spectrum, pregnancy BMI is greater than the 50, clinically significant bleeding disorders.

Or the other surgical medical high-risk factors. The part of the planning should develop a plan that allows the delivery at a facility with appropriate levels and the care that the patients will needs. 

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Can Uterine Atony Prevent?

No, the uterine atony is preventing, but when they diagnose this problem then he will help to manage these conditions through all the stages of the labor. If the patient is in the risk, then appropriate uterine atony nursing management procedures must be in a place.

The IV lines of the medical facility are ready to prescribe you medication and handy. They also give you are the equipment to deal with the blood loss after birth. The vital signs of the amount of bleeding that occurs by the afterbirth and monitor by the doctor to detect the hemorrhage. 

Oxytocin is the first line of the treatment still suggests helping the uterus contract after the delivery. Uterine massage has become a common practice post-delivery of the placenta to reduce the risk of symptoms and risk of the uterine atony.

Taking a regulates the dose of iron and the prenatal vitamin supplements also helps to prevent anemia. It will also help to reduce the complications of the postpartum uterine atony.  Uterine atony is the main cause of the primary hemorrhage condition., which makes excessive bleeding after birth. 

Fundal Massage For Postpartum Haemorrhage?

Bleeding after giving childbirth is the leading cause of maternal deaths in Egypt and Sub-Saharan Africa. It is also largely preventable. Some of the causes of having to bleed directly include childbirth or within the first 24 hours are the uterus fails to the uterine contractions after the delivery.

The retained placenta, inverted, or ruptured uterus and the cervical perineal tears. The good resources setting of the hemorrhage reduces by the routine of the active management of the delivery of the placenta, this is known as the third stage of the labor.

Some peoples are also used to oxytocin and some other drugs to stimulate the contraction of the bloody uterus. Uterine massage after the delivery of the placenta also helps to promote the contractions of the uterus.

The Uterine massage involves placing a hand on the woman’s uterus and stimulating the uterus by giving the squeezing movement or repetitive massaging.

There are some reviews which include the two controlled trials in which some women were randomly assigned to receive a uterine massage or no massage with the active management of the thirst stages of the labor, by including the routine uses of oxytocin. 

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Trial Review

In a one trial review 210 women are involved, Every day the uterine massage was given for the 10 to 60 minutes after the delivery of the placenta and the effective blood loss, and the need for additional uterotonics by some 80%.

The numbers of women who lost more than the 5mml of blood were too small for meaningful comparison. Only the two women in the control groups need a blood transfusion, but other women do not need a blood transfusion in the group of uterine massage.

In the second trial, 1000 women are involved. These women are assigned to receive the oxidation or uterine massage or both after and before the baby delivery. Doctors are not found any added benefits from the uterine massage when the oxytocin was used. 

The results of this study are inconclusive because the methodological quality of both two trials was too high. But it is possible that, the direct needs in the procedures are used in the study sites.

The disadvantages of the uterine massage include the use of the staff time and it also caused discomfort in women. The findings do not change the recommended practices. Also, any reduction in the blood loss was limited with the use of oxytocin in these reviews.

Also, uterine massage increases the apparent blood loss by pressing up the pooled blood out from the uterine cavity. But, there is also a need for more trials, especially for the setting where the uterotonic is not available. Uterine massage is a simple inexpensive intervention. 

Postoperative And Rehabilitation Care

Postpartum anemia is the common issue that occurs after an episode of the uterine atony and hemorrhage. The severe cases of the anemia which cause by the PPH may require red cell transfusions.

It also depends on the severity of the anemia and also the degree of the symptomatology which is attributable to the anemia. One of the common practices is to offer a transfusion to the symptomatic women with the hemoglobin values which is less than the 7g/dL.

In most of the cases, the uterine atony is relating to the postpartum hemorrhage, but the amount of the iron lost not fully replace by the transfused blood. The Orla iron also considers. Parenteral iron therapy is an option for the patients because it will accelerate the recovery.

Most of the women are with the milds to moderate the anemia, so, they resolve the anemia sufficiently with the oral iron alone and do not need parenteral irons. 

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