Uterine Atony: Definition, Prevention, Nonsurgical Management, and Uterine Tamponade

Division of Maternal Fetal Medicine, Columbia University Medical Center, New York, NY 10708, USA.
Seminars in perinatology (Impact Factor: 2.68). 05/2009; 33(2):82-7. DOI: 10.1053/j.semperi.2008.12.001
Source: PubMed


Uterine atony, or failure of the uterus to contract following delivery, is the most common cause of postpartum hemorrhage. This review serves to examine the prevention and treatment of uterine atony, including risk-factor recognition and active management of the third stage of labor. A range of uterotonic agents will be compared for efficacy, safety, and ease of administration. Oxytocin and ergot alkaloids represent the cornerstone of uterotonic therapy, while prostaglandin therapy has been studied more recently as an attractive alternative, particularly for resource-poor settings. Newer supplementary medical therapies, such as recombinant factor VII and hemostatic agents, and adjunctive nonsurgical methods aimed at achieving uterine tamponade will be evaluated.

68 Reads
  • Source

  • [Show abstract] [Hide abstract]
    ABSTRACT: The case A 39-year-old gravida 10 para 9 (G10P9) is admitted for treatment and evaluation to the obstetrics floor for abdominal pain. The obstetricians are telling you that the patient probably has placenta accreta and placenta previa on ultrasound. Furthermore, the obstetricians relate to you that the baby has no heart rate and no movement is visualized on ultrasound at 36 weeks' gestation. The patient has no significant past medical history. Her obstetric history is extensive, including five vaginal births and four previous cesarean sections. Her cesarean sections were complicated by uterine atony after each procedure, requiring blood transfusions and an intensive care unit stay for the last one. It is recommended to the patient that she undergo bilateral uterine artery embolization as well as abdominal hysterectomy to remove the dead fetus and to prevent postpartum hemorrhage from previa and accreta. The patient is devastated at the loss of her child and is refusing all medical care. She just wanted to be given some sedation and sleep. After extensive discussion with the patient and the obstetrician, it is determined that an initial attempt to perform a cesarean section will be made; if, however, the patient begins to have bleeding of any kind, no further attempts will be made to deliver the placenta, and the patient will then undergo abdominal hysterectomy. The patient is brought to the operating room and an epidural catheter is placed successfully with a T5 thoracic level obtained using 2% lidocaine with 1:200, 000 epinephrine, approximately 20 mL.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Postpartum hemorrhage (PPH) remains a significant contributor to maternal morbidity and mortality throughout the world. The majority of research on this topic has focused on efforts to prevent PPH. Sound data exist that active management of the third stage of labor can reduce the occurrence of PPH. Although there remains debate regarding the optimal protocol for active management, it appears at this time that oxytocin is the preferable uterotonic to use. Misoprostol may be a reasonable option where parenteral administration of an uterotonic is not feasible. There is little evidence to guide treatment decisions should PPH occur.
    Clinical obstetrics and gynecology 03/2010; 53(1):165-81. DOI:10.1097/GRF.0b013e3181ce0965 · 1.77 Impact Factor
Show more

Similar Publications