Uterine Atony: Group 3

Uterine Atony
Group 3
Definition
● RELAXATION OF THE UTERUS

● FAILURE OF THE UTERINE MYOMETRIUM TO
CONTRACT AND RETRACT FOLLOWING BIRTH
● MOST FREQUENT CAUSE OF POSTPARTAL
HEMORRHAGE
Signs & Symptoms
● uterus remains relaxed and
without tension after giving
birth
● excessive and uncontrolled
➔When bleeding is associated with
bleeding following the birth
uterine atony or retained
of the baby
placental fragments, the blood is
● decreased blood pressure
dark red with clots and the uterus
● an increased heart rate
is soft and boggy.
● pain
● a backache
● Uterine overdistention
● Large baby
● Multiple gestation
● Hydramnios
● Bladder distention
Risk Factors ● Prolonged first and/or

second labor
● Precipitous labor
● Labor induction with
Pitocin
● Tocolytic therapy
Anatomy
UTERUS
The uterus is a muscular organ that holds and nourishes the developing fetus
during pregnancy. Although the uterus is normally about the size of a fist,
during pregnancy it is capable of stretching to accommodate a fully developed
fetus, which is typically about 50 cm (about 20 inches) long and weighs about
3.5 kilograms (about 7.5 pounds). The uterine muscles also produce the strong
contractions of labor. The uterus has three layers, the perimetrium -- outermost
layer, the myometrium -- middle layer, and the endometrium -- innermost
layer, and is richly supplied with blood vessels and glands.
Pathophysiology
● The uterus must remain contracted after birth to control bleeding from
the placental site.
● Any factor that causes the uterus to relax after birth will cause bleeding—
even a full bladder that displaces the uterus.
● During the third stage of labor the muscles of the uterus contract
downward, causing constriction of the blood vessels that pass through
the uterine wall to the placental surface and stopping the flow of blood.
● This action also causes the placenta to separate from the uterine wall.
Pathophysiology
● The absence of uterine contractions may result in excessive blood loss.
● Over the course of pregnancy, maternal blood volume increases as much
as 50% (from 4 to 6 L).
● Given this increase, the typical signs of hemorrhage (e.g., falling blood
pressure, increasing pulse rate, and decreasing urinary output) do not
appear until as much as 1,800 to 2,100 mL of blood has been lost (Gilbert,
2011).
Nursing Diagnosis
• Risk for Deficient Fluid

Volume related to uterine
atony/ hemorrhage
NURSING
Laboratory RESPONSIBILITIES
and ● Nurses should educate

the clients about the
purposes, required
Diagnostic preparation,
procedures.
Procedure ● Explain that slight
discomfort may be felt
during the procedure
DURING:
● Preparing patients - Help the patient during the
procedure and give privacy.
● Monitor patients during testing - Monitor their
current medical condition, especially in those
patients deemed unstable.
● Apply manual pressure and dressings over puncture
site
AFTER:
● Reporting results - Test results are reported to the

patient's doctor, specialists, and others in need of the
information by nurses.
● Educate the client of the results and the implications of
abnormal and normal diagnostic tests including the
results of all laboratory tests and testing.
● Monitor the puncture site for oozing or hematoma
formation
LAB PROCEDURE NORMAL VALUES ANALYSIS
Complete Blood Count (CBC) Hgb: 12–14 g/dL Evaluates Hgb and Hct levels
Hct: 32--42% and RBC count to detect
RBC count: 3.75–5.0 million/mm3 presence
WBC level: 5,000–15,000/mm3 of anemia;
Platelet count: 150,000–350,000 identifies WBC level,
mm3 which if elevated may indicate
an infection;
determines platelet count to
assess clotting ability
LAB PROCEDURE
Blood Typing & Antibody Screening Test Determines woman’s blood type and Rh status to
rule out any blood
incompatibility issues early;
Rh-negative mother would likely receive
RhoGAM (at 28 weeks gestation) and again within
72 hours after
childbirth, if she is Rh sensitive
Crossmatching Used to check for harmful interactions between the

patient’s blood and specific donor blood or organs
DRUG
STUDY ● Misoprostol
● Oxytocin
DRUG MECHANISM OF INDICATION CONTRAINDICA- SIDE ADVERSE NURSING
ACTION TION EFFECTS EFFECTS RESPONSIBILITIES
Misoprostol Misoprostol Contraction None • Headache • Cramps • Explain purpose

(Cytotec) binds to of uterus • Nausea • Hyper and side effects
menorrhea
smooth muscle • Vomiting of the
• menstrual
cells in the • Diarrhea medication to
disorder
uterine lining to • Fever • dysmenorrhea the patient and
increase the • Chills her companion.
strength and • Monitor Vital
frequency of signs
contractions as • Continue to
well as degrade monitor vaginal
collagen and bleeding and
reduce cervical uterine tone
tone
DRUG MECHANISM INDICATION CONTRAINDI- SIDE EFFECTS ADVERSE NURSING
OF ACTION CATION EFFECTS RESPONSIBILITIES
Oxytocin Oxytocin Contraction None for PPH • Infrequent • Seizures • Explain purpose
• Hypotension
(Pitocin) promotes of uterus; : water and side effects
• Tachycardia
contractions decreases • Intoxicatio • Cardiac of the
by increasing bleeding n arrhythmias medication to
the • Nausea the patient and
intracellular and her companion.
Ca2+, which vomiting • Monitor Vital
in turn signs
activates • Continue to
myosin's monitor vaginal
light chain bleeding and
kinase.. uterine tone
Surgical Management
● HYSTERECTOMY OR SUTURING
○ Usually, therapeutic management is
effective in halting bleeding. In the rare
instance of extreme uterine atony, sutures
or balloon compression may be used to halt
bleeding (Nelson & O’Brien, 2007).
Medical Management
●Continuous IV infusion of 10 to 40 units of oxytocin added to 1000mL of lactated
Ringer’s or normal saline solution also are primary interventions.
●Prostaglandin Administration.
○Prostaglandins promote strong, sustained uterine contractions.
●If a woman is experiencing respiratory distress from decreasing blood volume,

administer oxygen by face mask at a rate of about 4 L/min.
●If the uterus fails to respond to oxytocin, other uterotonic medications are
administered. Misoprostol (Cytotec), a synthetic prostaglandin E1 analog, is often used.
Nursing Management
Before
● Explain to the client and family what is happening and what therapies are being
instituted.
● Assist the family to express their feelings and provide support as needed. Inform
and reassure the woman and family as much as possible during this crisis.
● Offer a bedpan or assist the woman with ambulating to the bathroom at least
every 4 hours to be certain her bladder is empty.
● Position her supine to allow adequate blood flow to her brain and kidneys.
Nursing Management
During
● The first step in controlling hemorrhage is to attempt uterine
massage to encourage contraction.
● If a woman is experiencing respiratory distress from decreasing blood

volume, administer oxygen by face mask at a rate of about 4 L/min.
After
● Obtain vital signs frequently and make sure to interpret them
accurately, looking for trends.
Nursing Care Plan
Assessment Diagnosis Planning
Subjective: Risk for Deficient Fluid Volume Within 1 hour of nursing

“Nanghihina ako, as verbalized related to uterine atony/ intervention,
by the patient.” hemorrhage
• The fundus will be firm
Objective:
• Vital Signs: • Lochia will become
T:35.5 ˚C moderate
PR:74 bpm
RR:22 bpm • There will be no signs of
BP:100/60 mm Hg hemorrhage.
• Pallor
INTERVENTIONS RATIONALE EVALUATION
INDEPENDENT • To evaluate amount of After 1 hour of
• Monitor lochia (color, amount, bleeding nursing intervention,
consistency) and count sanitary pads if
lochia is heavy • The fundus is
• Because uterine atony is firm.
• Monitor and palpate fundus for location most common cause of
and tone to determine status of uterus postpartum haemorrhage • Lochia is
and dictate further interventions moderate.
• Because a full bladder
• Monitor intake and output, assess for interferes with involution of • There are no
bladder fullness, and encourage voiding uterus evidence of
haemorrhage.
• Monitor vital signs (increased pulse and • To detect signs of
respirations, decreased blood pressure) hemorrhage/shock • Vital Signs:
and skin temperature and color T:36.5 ˚C
PR:88 bpm
• Monitor postpartum hematology studies • To stimulate uterine RR:17 bpm
To assess effects of blood loss If fundus contraction BP:110/70 mm Hg
is boggy, apply gentle massage and
assess tone response.

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Uterine Atony

● RELAXATION OF THE UTERUS

Risk Factors ● Prolonged first and/or

• Risk for Deficient Fluid

and ● Nurses should educate

● Reporting results - Test results are reported to the

Crossmatching Used to check for harmful interactions between the

Misoprostol Misoprostol Contraction None • Headache • Cramps • Explain purpose

●If a woman is experiencing respiratory distress from decreasing blood volume,

● If a woman is experiencing respiratory distress from decreasing blood

Subjective: Risk for Deficient Fluid Volume Within 1 hour of nursing

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