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What is Uterine Atony?
Written by Medicover Team and Medically Reviewed by Dr Amatul Hafsa , Gynecologists
Uterine atony (uterine tone) is a condition that happens right after childbirth when the uterus (womb) doesn't contract the way it should. Normally, the uterus tightens or squeezes after delivery to help stop bleeding. But in uterine atony, it stays soft or relaxed, leading to heavy bleeding, which can be serious if not treated quickly.
This is one of the most common causes of postpartum hemorrhage (excessive bleeding after giving birth). Atony of the uterus usually occurs within the first 24 hours after delivery, though it can happen a bit later, too.
If the uterus doesn't contract properly:
- Blood vessels inside it stay open
- This causes continuous bleeding
- Immediate medical care is needed to prevent complications
Key points to remember:
- It can happen after both normal delivery and C-section
- It's more common if labor was long or the baby was very large
- The uterus may feel soft or "boggy" when touched
- Prompt treatment usually stops the bleeding and avoids serious problems
While it sounds scary, doctors are trained to spot and treat uterine atony quickly. Medications, massages, and sometimes surgical steps are used to help the uterus contract and control bleeding.
What Are the Types of Uterine Atony?
Uterine atony means the uterus isn't tightening (contracting) the way it should after childbirth. This can lead to heavy bleeding, which needs quick medical care. While uterine atony itself is one condition, it can appear in different ways depending on what's causing it or how it behaves during or after delivery. Here are the main types or patterns doctors may observe:
Primary Uterine Atony
This is the most common form and happens immediately after childbirth. The uterus fails to contract at all or only contracts weakly.
- Often linked to long labour or an overfilled uterus (with twins or too much fluid).
- Bleeding starts soon after the baby is delivered.
- Usually managed quickly in the delivery room.
Secondary Uterine Atony
In this case, the uterus may have contracted at first, but then relaxes again after some time.
- It can occur in the hours following delivery.
- It may be triggered by retained placenta parts or infection.
- Often requires close monitoring in the hospital.
Partial Uterine Atony (less common)
Here, only part of the uterus contracts while another part remains soft.
- Can lead to hidden (internal) bleeding.
- Harder to detect without a careful check.
Each type needs fast action, but the treatment may vary slightly depending on the cause.
What Are the Uterine Atony Symptoms?
Uterine atony means the uterus muscles stay loose, which can lead to heavy bleeding. It's one of the most common causes of postpartum hemorrhage (severe bleeding after delivery) and needs quick medical attention.
The symptoms usually appear shortly after childbirth, often in the first few minutes to hours. It's important for new mothers, families, and medical staff to recognise these signs early to avoid complications. If you or someone you know recently gave birth and notices unusual bleeding or other concerning signs, don't wait, call for help right away.
Common Symptoms of Uterine Atony:
- Heavy bleeding from the vagina that doesn't slow down
- Soft, boggy, or relaxed uterus when touched by a doctor or nurse
- Low blood pressure or feeling lightheaded and dizzy
- A fast heartbeat (pulse) as the body tries to handle the blood loss
- Paleness or cold, clammy skin
- Feeling weak, tired, or faint
- Pain in your back
Always report any unusual or excessive bleeding after delivery to your healthcare provider immediately. With the right treatment, uterine atony can be managed safely.
What Are the Causes of Uterine Atony or Atony of the Uterus?
Normally, the uterus should tighten to help stop bleeding once the baby and placenta are delivered. When this doesn't happen, heavy bleeding (postpartum hemorrhage) can occur.
There are a few common reasons why the uterus may fail to contract:
- Overstretched uterus: This can happen if you're carrying twins or a large baby.
- Long labor or very fast labor: Both can tire out the uterus.
- Too much amniotic fluid: This stretches the uterus more than usual.
- Use of certain medications: Some labor drugs, like oxytocin, when used for too long, may reduce how well the uterus responds.
- Placenta issues: Retained pieces of placenta can keep the uterus from tightening.
- Infections or inflammation: These can interfere with uterine muscle function.
In short, uterine atony is usually caused by the uterus being overworked, overstretched, or not given the right signals to contract after birth. Quick treatment is essential to prevent heavy blood loss and other complications.
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Get Second OpinionWho Is at Risk for Uterine Atony?
Some women are more likely to develop uterine atony after childbirth. This condition happens when the uterus doesn't contract the way it should after delivery, leading to heavy bleeding. Knowing the risk factors can help both you and your doctor be better prepared.
Here are some common personal risk factors:
- It's your first baby, or you've had five or more deliveries in the past.
- You're expecting twins, triplets, or more.
- Your baby is larger than average (a condition called fetal macrosomia).
- You're over the age of 35.
- You have too much amniotic fluid (known as polyhydramnios).
- You're living with obesity.
- You have uterine fibroids (non-cancerous growths in the uterus).
Certain labor and delivery factors also increase the risk:
- Very long or very quick labor
- Complicated labor
- Induced labor using medications
- Infection during labor, such as chorioamnionitis
- Use of general anesthesia
- An unusually large uterus
If you have two or more of these factors, your care team may take extra precautions during and after delivery. At Medicover, we closely monitor high-risk pregnancies and prepare in advance to ensure you receive fast, effective care when it matters most.
How Is Uterine Atony Diagnosed?
Uterine atony is usually diagnosed right after childbirth, especially if the mother is bleeding more than expected. Doctors and nurses are trained to spot the signs quickly to prevent complications. Since it's a serious condition, the diagnosis is often based on physical symptoms and how the uterus feels during an exam.
After the baby is delivered, the doctor or nurse will check the firmness of your uterus. If the uterus feels soft and doesn't contract as it should, it may indicate uterine atony.
Here's how it's usually diagnosed:
- Checking for excessive bleeding after delivery
- Feel the uterus through the abdomen to see if it's soft or "boggy" instead of firm
- Monitoring vital signs, such as a drop in blood pressure or a fast heart rate, which may signal blood loss
- Reviewing delivery details, such as a long labor, multiple births, or the use of certain medications, which can increase the risk
If uterine atony is suspected, the medical team acts quickly. They may begin treatment even before test results, because timely action is crucial to avoid heavy blood loss.
How Is Uterine Atony Treated?
Uterine atony is a condition where the uterus doesn't contract properly after childbirth, which can lead to heavy bleeding. It's a serious but treatable condition. The main goal of Uterine Atony treatment is to help the uterus contract and stop the bleeding quickly.
Uterine Atony Doctors usually start with simple methods and move to advanced ones if needed. Here's how it's commonly treated:
- Uterine massage: Gently massaging the top of the uterus helps stimulate contractions. This is often the first step.
- IV fluids and blood transfusion: If there's a lot of blood loss, fluids or blood may be given to support the body.
- Catheter insertion: A urinary catheter may be used to help the uterus contract better.
- Surgery: In rare cases, if nothing else works, surgery may be needed to stop the bleeding. This includes Uterine curettage, Uterine artery ligation, Uterine artery embolisation, and Hysterectomy.
Getting quick care makes a big difference. Uterine atony is treatable, and most women recover well with proper medical support.
Uterine Atony Medications
When the uterus isn't contracting after childbirth, doctors use specific medicines to help it tighten and stop the bleeding. These medications are called uterotonics. They encourage the uterus to contract, just like it does naturally during labor.
Here are the common medicines used:
- Oxytocin (Pitocin): Usually, the first medicine given through an IV. It helps the uterus contract quickly.
- Misoprostol: Given by mouth, under the tongue, or rectally. It's often used when oxytocin alone isn't enough.
- Methylergometrine (Methergine): Helps with strong uterine contractions, but is not used in women with high blood pressure.
- Carboprost (Hemabate): A strong medicine used when bleeding doesn't stop with other drugs. Not given to women with asthma.
These medications are given quickly, and their effects are usually fast. Doctors choose the right one based on the mother's health and how the bleeding responds. Some women may need more than one medicine to control the bleeding.
Tamponade Techniques (Applying Pressure to the Uterine Walls)
When medicines and massage don't stop the bleeding caused by uterine atony, doctors may use tamponade techniques. This method involves placing something inside the uterus to apply pressure to the walls and stop the bleeding, much like applying pressure to a wound helps it stop bleeding.
Here's how it's done:
- Uterine balloon tamponade: A special balloon (such as a Bakri balloon) is gently inserted into the uterus and filled with saline or fluid. This balloon presses against the uterine walls to slow or stop the bleeding.
- Uterine packing: If a balloon is not available, doctors may use sterile gauze or cloth to pack the uterus. The pressure helps blood vessels close.
- Simple and safe: These methods are often successful and can prevent the need for surgery.
- Temporary: The balloon or packing is usually left in place for a few hours, then carefully removed once bleeding has stopped.
These techniques are quick to set up and often very effective. They're used in hospitals with trained staff and can be life-saving when bleeding is heavy and not stopping with medicines alone.
When to See a Doctor for Uterine Atony?
Uterine atony is a serious condition that can lead to heavy bleeding, which needs immediate medical attention. Knowing the signs early can help save lives.
You should see a doctor or go to the hospital right away if you notice:
Even if you're unsure, it's always better to be safe. Heavy bleeding after childbirth is not normal and shouldn't be ignored. Proper medical care can help stop the bleeding, prevent complications, and support your recovery.
If you're still in the hospital and notice these symptoms, tell your nurse or doctor immediately. If you're already at home, call emergency services or go to the nearest hospital without delay.
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What Is the Recovery Process After Uterine Atony Treatment?
Recovering from uterine atony depends on how much blood loss occurred and the type of treatment received. If it was managed quickly, recovery is usually smooth. But you may feel weak or tired for a few days due to blood loss.
Here's what to expect during recovery:
- Rest: Your body needs time to heal, especially after childbirth and treatment.
- Follow-up checkups: These ensure the uterus is shrinking normally and no infection has developed.
- Watch for warning signs: Report symptoms like fever, heavy bleeding, or severe cramping.
Most women recover well within a few weeks. Listen to your body and don't hesitate to reach out to your doctor with any concerns.
What Precautions Can Help Prevent Uterine Atony?
While not all cases of uterine atony can be prevented, some simple steps before and during childbirth can lower the risk.
Here are some helpful precautions:
- Regular prenatal checkups: These help monitor your pregnancy and spot any risks early.
- Stay healthy during pregnancy: Eating well, staying active, and managing any health issues can support a healthy uterus.
- Inform your doctor about past deliveries: If you had uterine atony before, your doctor will take extra care.
- Skilled birth team: Delivering in a well-equipped hospital with trained staff ensures fast action if needed.
Being prepared and having the right care can make a big difference during delivery.
What Are the Possible Complications of Uterine Atony?
Uterine atony, or Atony of the uterus, can be serious if not treated quickly, as it may lead to heavy blood loss. However, with proper care, most women recover well.
Still, it's good to be aware of possible complications:
- Severe blood loss (hemorrhage): Can lead to weakness, dizziness, or shock.
- Blood transfusion: May be needed if a large amount of blood is lost.
- Infection: Risk increases if clots remain or the uterus doesn't shrink properly.
- Longer hospital stay: For observation or recovery from related procedures.
- Impact on future pregnancies: If you've had uterine atony before, future deliveries may be more closely monitored.
The good news? With timely care and support, most women go on to have healthy recoveries and future pregnancies.
Our Experience Treating Uterine Atony (Uterine Tone)
At Medicover, we understand how overwhelming and scary it can be to face complications like Uterine atony after childbirth. But the good news is, it's treatable when caught early, and our expert team is here for you.
We handle these situations with urgency and care. Our experienced gynecologists and emergency teams are trained to act fast, using proven treatments to stop the bleeding and help your uterus regain its tone.
Whether it's through medications, massage, or surgical support when needed, we make sure you are treated safely and with compassion.
Your safety and recovery are our top priorities, from the delivery room to full recovery.
