Uterine atony

Ergonovine and methylergonovine both increase the strength, duration, and frequency of uterine contractions and decrease the incidence of uterine bleeding. They are given after the delivery of the placenta and are used to prevent postpartum and postabortal hemorrhage caused by uterine atony (marked relaxation of the uterine muscle). 

It increase force, frequency and duration of uterine contractions. It is used to control and prevent postpartum haemorrhage. It is also used to prevent uterine atony after cesarean or instrumental delivery. 

Before delivery, oxytocin is usually administered intravenously via an infusion pump with appropriate fetal and maternal monitoring. For induction of labor, an initial infusion rate of 0.5-2 mU/min is increased every 30-60 minutes until a physiologic contraction pattern is established. The maximum infusion rate is 20 mU/min. For postpartum uterine bleeding, 10-40 units are added to 1 L of 5% dextrose, and the infusion rate is titrated to control uterine atony. Alternatively, 10 units of oxytocin can be administered by intramuscular injection after delivery of the placenta. 

Hayashi RH, Castillo MS, Noah ML. Management of severe postpartum hemorrhage due to uterine atony using an analogue of prostaglandin F2 alpha. Obstet Gynecol 1981 58(4) 426-9. 

Carboprost is a 15-methylated analogue of PGF2a- It is used in termination of pregnancy, in the management of labor, and to treat postpartum hemorrhage and uterine atony. 

A 30-year-old woman developed uterine atony and bleeding after induced abortion because of fetal death at 17 weeks of gestation (4). Sulprostone was given intravenously at a rate of 500 micrograms/hour. When additional sulprostone was injected into the uterine cervix, the patient sustained a myocardial infarction, with ventricular fibrillation and cardiocirculatory arrest, most probably due to coronary artery spasm. She was resuscitated and recovered completely. 

Kulka PJ, Quent P, Wiebalck A, Jager D, Strumpf M. Myocardial infarction after sulprostone therapy for uterine atony and bleeding a case report. Geburtshilfe Frauenheilk 1999 59 634-7. 

Dansereau J, Joshi AK, Helewa ME, Doran TA, Lange IR, Farine D, Schulz ML, Horbay GL, Griffin P, Wassenaar W. Double-blind comparison of carbetocin versus oxytocin in prevention of uterine atony after cesarean section. Am J Obstet Gynecol 1999 180(3 Pt l) 670-6. 

Blue cohosh is said to possess antispasmodic, emmenagogue, uterine tonic, and antirheumatic properties. Traditionally, it has been used for amenorrhea, threatened miscarriage, false labor pains, dysmenorrhea, rheumatic pains, and specifically for conditions associated with uterine atony. 

Dantrolene may have contributed to uterine atony, with resulting excessive hemorrhage when given prophylacti-cally after a cesarean section (12). 

Weingarten AE, Korsh JI, Neuman GG, Stern SB. Postpartum uterine atony after intravenous dantrolene. Anesth Analg 1987 66(3) 269-70. 

Trade names Duratocin Lonactene Pabal (Ferring) Indications Prevention of uterine atony following delivery of the infant by cesarean section under epidural or spinal anaesthesia. Category Oxytocic Half-life 40 minutes... 

Oxytocin (0.5 miUiunits/min) is indicated to induce term labor, to control postpartum hemorrhage, to prevent postpartum uterine atony, to expel the placenta, and to prevent postpartum breast engorgement. 

Routine management after delivery of the placenta, uterine atony, and hemorrhage Antepartum to initiate or improve uterine contractions postpartum to produce uterine contractions in third stage of labor, control of postpartum bleeding and hemorrhage... 

ERGONOVIN E AN D M ETHYLERGONOVIN E When novine or mediylergonovine is administered for uterine atony and hemorrhage abdominal cramping can occur and is usually an indication of drug effectiveness. The uterus is palpated in the lower abdomen as small, firm, and round. However, die nurse should report persistent or severe cramping to the primary health care provider. 

S X rd 0 IV/IM/nasal. Short half-life (3-5 min.). Potential for uterine tetany or rupture, trauma to infant, post -delivery uterine atony. Prolonged infusion (>24h) may cause water intoxication (antidiuretic activity). Potentiates hypertensive effects of other drugs. May cause stroke/hemorrhage, fetal distress. Synthetic oxytocin mimics the effects of endogenous oxytocin which is released from the hypothalamus. 

A report of 37,497 women who delivered in the UK in 1988 showed that in addition to the well-known risk factors to major PPH, other potential risks were obesity, a large baby, and a retained placenta in women classified initially as low risk [27]. The most common cause of PPH is uterine atony. It occurs in 2%-5% of deliveries. However, the majority is managed by conservative measures. Other causes of PPH are retained products of conception. 

Since the first embolization of PPH performed by Brown in 1979, the reported success rate in 138 patients over a 20-year period was as high as 94.4% [35-43]. To date, 160 patients have been treated at our institution (the first author s institution) by selective uterine and/or internal iliac arteries embolization for intractable bleeding following delivery. Despite the variety of the etiologies and risk factors in our series, no maternal deaths were observed. The main cause of hemorrhage was related to uterine atony, with an incidence of 75%. Cesarean delivery... 

Uterine artery embolization (UAE) is an established technique that has been used to stop life-threatening vaginal hemorrhage in women with malignancy, postpartum uterine atony, or traumatic injury since the mid-1970s [8,18,52,64,112]. The first successful treatment of symptomatic fibroids of the uterus by UAE was reported by Ravina et al. in 1994 [150]. 

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