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Postpartum hemorrhage
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Wade D. Schwendemann, William J. Watson
Treatment for atony involves uterine massage, IV fluid resuscitation, and administration of uterotonic agents. In addition to the oxytocin recommended for prophylaxis, further oxytocin can be given. Doubling the previously mentioned dose is a recommended first step. Other medications can be provided as well. These are summarized in Table 1.
Primary Postpartum Haemorrhage
Published in Sanjeewa Padumadasa, Malik Goonewardene, Obstetric Emergencies, 2021
Sanjeewa Padumadasa, Malik Goonewardene
Anything that interferes with the ability of the uterus to contract and retract, causes uterine atony, the most common cause of primary PPH, and accounts for 80%–85% of cases. Risk factors for uterine atony are listed in Table 14.2. However, the majority of cases of uterine atony occur in women with no risk factors. Therefore, primary PPH is largely unpredictable, and every birth attendant should be able to adopt appropriate preventive measures, anticipate and detect excessive bleeding early on and quickly commence appropriate initial management, if it indeed occurs.
Obstetrics in Limited-Resource Settings
Published in Mansoor Khan, David Nott, Fundamentals of Frontline Surgery, 2021
Carlos Pilasi Menichetti, Rebekka Troller
Rapid assessment, resuscitation, and observations (HR, BP, RR) should be undertaken. The patient should lie flat. Uterine atony is treated by bimanual uterine compression and massage, followed by drugs (Oxytocin 20 IU L−1 of normal saline, Carboprost 0.25 mg IM, Misoprostol (Cytotec) 1000 mcg rectally, Methylergonovine 0.2 mg IM). Two large-bore cannulas and blood test should be sent; then the bladder must be catheterised.
How to boost an obstetrician's confidence in vaginal delivery after high-intensity focused ultrasound: a comparison study on delivery outcomes
Published in International Journal of Hyperthermia, 2022
Jinping Gu, Bin Lin, Zhengyu Guo, Aixingzi Aili
Common causes of PPH include uterine atony, trauma, retained placental tissue, and failure of the blood coagulation system, with uterine atony accounting for the majority of cases (75–90%) [32]. Uterine atony is defined as the inability of the uterus to contract after the fetus has been expelled [33]. According to our research, contraction of the uterus is associated with PPH (aOR: 17.177, 95% CI:5.046 ∼ 58.472, p = 0.000), and this finding is consisted with the expert consensus. The rate of using more than two types of uterotonic medications to promote contraction is significantly lower in the Qualified Candidates for TOLAH group (54.05 percent vs 69.84 percent, p = 0.04), and the percentage of abnormal uterine contraction is lower in the Qualified Candidates for TOLAH group (35.14 percent vs 49.18 percent, p = 0.072). We believe that the uterine contraction ability is unaffected by HIFU, which explains the low incidence of PPH after HIFU. The ability of uterine contraction after HIFU has received less attention in prior literature. Only one case of PPH due to uterine atony after HIFU was found in Li's analysis of 93 full-term births [19]. Following HIFU, the reduction of myoma volume or the ablation inside myomas is beneficial to contraction ability. This point of view needs more studies to concentrate on.
Feasibility of using a handheld tissue hardness meter to quantify uterine contractions and its clinical application for obstetric bleeding management
Published in Journal of Obstetrics and Gynaecology, 2019
Kenji Imai, Tomomi Kotani, Takafumi Ushida, Yoshinori Moriyama, Tomoko Nakano, Fumitaka Kikkawa
Postpartum haemorrhage (PPH) is a potentially life-threatening condition and a significant contributor to maternal mortality worldwide (Lalonde et al. 2006). The risk of PPH is much higher for women undergoing caesarean section (CS) than vaginal delivery (Wedisinghe et al. 2008; Takeda et al. 2017). Thus, the need for improving the management of PPH during CS has become an unavoidable issue. The most frequent cause of PPH is uterine atony (Whiteman et al. 2006). Maintaining adequate uterine contraction leads to prevention of excessive blood loss after placental removal, which decreases the incidence and severity of PPH. However, the assessment of uterine contraction is currently judged by obstetricians, who manually and subjectively evaluate uterine contraction according to uterine hardness (Carvalho et al. 2004; Balki et al. 2006; Butwick and Carvalho, 2010). Therefore, uterine atony remains a clinical diagnosis without a universal definition. The best clinical approach to evaluate uterine contraction would be to measure uterine hardness quantitatively, using currently available noninvasive methods.
‘Neurasthenia gastrica’ revisited: perceptions of nerve-gut interactions in nervous exhaustion, 1880–1920
Published in Microbial Ecology in Health and Disease, 2018
Surgery was also sometimes recommended in cases where gastric atony or ptosis of one of the abdominal organs was perceived as a main cause of the neurasthenic symptoms [47,56]. For instance, the American surgeon John F. Sheldon argued that in cases where the neurasthenia could be seen as secondary to gastric atony and associated complications, a ‘gastro-enterostomy, with closure of the pylorus’ would give the patients ‘complete and permanent relief, not only from the stomach symptoms, but also from the neurasthenia and constipation’ [57, p. 36]. In the cases of ptosis, George N. Kreider was of the opinion that ‘hundreds – yes, thousands – of women have been condemned to a miserable existence as hysterics or neurasthenics, who could be relieved if their abdominal ptosis were considered and relieved by bandages or operation’ [47, p. 2036]. Other physicians were far more critical and warned strongly against the use of surgical treatment in such cases, arguing that ‘no operation will take away the muscular atony but will rather aggravate it’ [46, p. 310].