OBSTETRICS : HYPOTONIA OF THE UTERUS, HYPOTONIC BLEEDING - etiology, pathogenesis, symptoms and course of, recognition, prediction and prevention
Hypotonia of the uterus, hypotonic bleeding - lowering ability of the muscles of the uterus to contract, leading to insufficient clamping of the vessels of the uterus and as a result to bleeding in succession and the postpartum period.
Causes of hypotonic condition of the uterus: hypoplasia of the uterus, birth in elderly primiparae giving birth women with a history of a large number of abortions; hyperextension of the uterus when polyhydramnios and multiple pregnancy, the presence of myomatous nodes in the uterus, intoxication with feverish childbirth. To hypotonia of the uterus may cause overfilling of the bladder and rectum. The main and most frequent cause of hypotonic hemorrhage is incorrect management succession period, kneading and massage of the abdominal wall and uterus to the placenta, giving the mother at this time reduces the uterus funds, especially preparations of ergot. In rare cases, the cause of hypotonic hemorrhage in succession period are anomalies of the placenta (incremental slice, the ring shape of the placenta, the increment of the placenta and other).
In practical terms, it is convenient to divide hypotonic hemorrhage in bleeding in the presence of the placenta in the uterus and bleeding after the birth of the whole or the greater part of the placenta from the genital tract.
The recognition is based on these symptoms. It is important to distinguish between hypotonic bleeding from bleeding caused by the rupture of the cervix and vagina (see).
Prevention involves the proper management of labour, in particular the succession period.
The treatment has two objectives:
To achieve this, the physician with the following activities:
Bleeding after the birth of the whole or the greater part of the placenta from the genital tract depends on detention in the uterus part of the placenta, overflow it with blood clots or true hypotension uterus.
Treatment. Vigorous uterine contractions by applying ergotine, pituitrin. In order to more vigorous action they can enter into the tissue of the cervix. With the same purpose apply massage of the uterus. With the failure of these measures, and at the slightest suspicion on the possibility of leaving in the uterus part of the placenta (data examination of the placenta, torn, crushed placenta, megadelta placenta) requires manual examination of the uterus and removing the existing placental debris and blood clots. The uterus is then usually well reduced, and the bleeding stops. The tone of the uterus to support the appointment of ergotine, pituitrin, aqueous extract of ergot and periodic massage of the uterus. With the failure of the specified treatment that depends on the true hypotension uterus, which are associated with neuromuscular structure and functional condition of the uterus, it is necessary to apply the most energetic means to immediately stop the bleeding:
Achieving these techniques at least a temporary cessation of bleeding, in a more relaxed atmosphere to prepare everything for persistent bleeding.
For upcoming events, if they will need include:
After stopping atonic bleeding postpartum women should remain under close medical supervision for at least 2 - 4 hours, as bleeding may recur. To prevent the possible development of an infection shows the use of penicillin (25 000 units 3 hours for 2 to 3 days, a total of 400 000 - 600 000 units) and sulfa drugs. When developed postpartum infection - treatment by the General rules (see Postpartum infectious diseases).