Management of Postpartum Uterine Atony

Initial Management

• Uterine atony is the most common cause of postpartum hemorrhage (>75% of cases) and is typically a clinical diagnosis 1, 2
• Begin with uterine massage to stimulate contractions 3, 4

Second-Line Treatments

• Methylergonovine is contraindicated in hypertensive patients due to risk of vasoconstriction 5

Advanced Interventions

• Uterine tamponade using intrauterine balloons or packing can be used for refractory uterine atony 6
• Surgical options for refractory uterine atony include bilateral uterine artery ligation, B-Lynch compression suture, and hysterectomy for extreme cases 6

Special Considerations

• Thoroughly inspect the cervix and vagina to rule out lacerations that may contribute to bleeding 6, 7
• In cases of massive hemorrhage, implement early aggressive resuscitation with blood products (packed red cells, fresh-frozen plasma, and platelets at a 1:1:1 ratio) 6, 7
• Assess for coagulopathy, which may develop following cardiovascular collapse 6, 7

Common Pitfalls to Avoid

• Using methylergonovine in patients with hypertension is contraindicated due to risk of severe hypertension 5
• Misdiagnosing amniotic fluid embolism based solely on hemorrhage from persistent atony with secondary coagulopathy 6, 7

Management of Uterine Atony

Assessment and Management of Coagulopathy

• Assess for coagulopathy, which may develop following cardiovascular collapse or massive transfusion, as recommended by the American College of Obstetricians and Gynecologists 8

Advanced Interventions for Refractory Atony

• Uterine artery embolization may be considered in hemodynamically stable patients who have failed medical management and non-surgical interventions, according to the American College of Radiology 8