Atoni literally means no tone, that is, no contraction
(a-toni). In reality, the uterus contracts and hardens immediately after both
normal delivery and cesarean, thereby preventing excessive bleeding after
delivery (postpartum). If the uterus cannot contract, excessive bleeding begins
after birth, and this is called uterine atony-related bleeding. Uterine atony
is also called as the uterus does not contract and harden after birth.
Sometimes bleeding stops soon and the uterine tone returns. However, in some
cases, it takes too long and can cause excessive bleeding. Uterine atonia is
the most common cause of excessive bleeding after birth.
Uterine
atony risk factors:
- When the uterus is overstretched, such as polyhydramnios
- Twin, triplet pregnancy
- Macrosomia
- Grand multiparite (giving birth to 5 or more)
- precipitate delivery
- Prolonged labor
- General anesthesia to the mother
- Use of drugs that relax the uterus, magnesium sulfate
- Induction of birth with oxytocin
- Having a history of atony in the mother's previous births
- Chorioamnionitis
- Large fibroids located in the uterus
- Manual removal of the placenta
- Obesity
Diagnosis:
In any period after birth, it is suspected that there is more
than normal bleeding, and if it is determined that it is not contractile and
soft in the manual examination of the uterus, the diagnosis becomes definitive.
Ultrasound or other diagnostic methods can help eliminate other bleeding
causes. Ultrasonography does not directly benefit in the diagnosis of atony.
Treatment:
Drugs that provide manual massage and contraction of the
uterus (oxytocin, methylergonovin, prostaglandins) are sufficient for treatment
in most cases.
In more severe and unstoppable bleeding, surgical methods
such as uterine artery embolization or ligation, hypogastric artery ligation,
or B-lynch suture are used. In cases where these are not useful, it may be
necessary to remove the uterus completely with hysterectomy surgery.
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