WordNet

of or involving the uterus; "uterine cancer"

PrepTutorEJDIC

子宮の / 同母異父の
(生体の組織の)無力[症],弛緩(しかん)

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/09/02 15:53:09」(JST)

wiki en

Uterine atony is a loss of tone in the uterine musculature. Normally, contraction of the uterine muscle compresses the vessels and reduces flow. This increases the likelihood of coagulation and prevents bleeds. Thus, lack of uterine muscle contraction can cause an acute hemorrhage. Clinically, 75-80% of postpartum hemorrhages are due to uterine atony.

Risk factors

Many factors can contribute to the loss of uterine muscle tone, including:^[1]

- overdistention of the uterus
- multiple gestations
- polyhydramnios
- fetal macrosomia
- prolonged labor
- oxytocin augmentation of labor
- grand multiparity (having given birth 5 or more times)
- precipitous labor (labor lasting less than 3 hours)
- magnesium sulfate treatment of preeclampsia
- chorioamnionitis
- halogenated anesthetics
- uterine leiomyomata

- full bladder

- retained colyledon, placental fragments

- placenta previa

- placental abruption

- constriction ring

- incomplete separation of the placenta

Treatment

The first step in management of uterine atony is uterine massage. The next step is pharmacological therapies, the first of which is oxytocin, used because it initiates rhythmic contractions of the uterus, compressing the spiral arteries which should reduce bleeding. The next step in the pharmacological management is the use of methylergometrine, which is an ergot derivative, much like that use in the abortive treatment of migraines. Its side effect of hypertension means its use should not be used in those with hypertension or pre-eclampsia. In those with hypertension, the use of prostaglandin F_2α is indicated (but beware of its use in patients with asthma). Another option Carbetocin and Carboprost where Oxytocin and ergometrin is inappropriate.

Notes

^ Breathnach F, Geary M. Uterine atony: definition, prevention, nonsurgical management, and uterine tamponade. Semin Perinatol 2009;33(2):82-7. PMID 19324236.

References

Hacker, Neville, J. G. Moore, and Joseph Gambone. Essentials of Obstetrics and Gynecology. 4th ed. Vol. 1. Philadelphia: Elsevier Inc., 2004. 151.

This human reproduction article is a stub. You can help Wikipedia by expanding it.

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. 産後出血の概要 overview of postpartum hemorrhage
2. 経腟分娩後の出血管理 management of postpartum hemorrhage at vaginal delivery
3. 帝王切開分娩後の出血管理 management of postpartum hemorrhage at cesarean delivery
4. Second-trimester pregnancy termination: Dilation and evacuation
5. 産後出血を制御するための子宮内バルーンタンポナーデ intrauterine balloon tamponade for control of postpartum hemorrhage

English Journal

Incidence, management and outcome of women requiring massive transfusion after childbirth in the Netherlands: secondary analysis of a nationwide cohort study between 2004 and 2006.

Ramler PI1,2, van den Akker T3, Henriquez DDCA3,4, Zwart JJ5, van Roosmalen J3,6.
BMC pregnancy and childbirth.BMC Pregnancy Childbirth.2017 Jun 19;17(1):197. doi: 10.1186/s12884-017-1384-7.
PMID 28629440

Uterotonic Medications: Oxytocin, Methylergonovine, Carboprost, Misoprostol.

Vallera C1, Choi LO2, Cha CM2, Hong RW2.
Anesthesiology clinics.Anesthesiol Clin.2017 Jun;35(2):207-219. doi: 10.1016/j.anclin.2017.01.007. Epub 2017 Mar 30.
PMID 28526143