Signs and symptoms of uterine atony.
(a) Signs of shock--decreased blood pressure, increased pulse, and
increased and anxiety and irritability.
(b) Bleeding-usually dark with clots present.
Noncontracted, boggy uterine fundus.
(a) Intervenously fluids administered to increase fluid and blood
(b) Oxytocin administration.
(c) Methergine/prostin may be administered to stimulate uterine
contractions when oxytocin is ineffective.
(d) Blood transfusion if the patient's hematocrit drops too low and/or if
she is symptomatic.
(a) Palpate the fundus frequently to determine continued muscle tone.
(b) Massage the fundus, if boggy, until firm (do not over massage, this
fatigues the muscle).
Monitor patient's vital signs every 15 minutes until stable.
(d) Prevent bladder distention. Bladder distention displaces the uterus
and prevents effective uterine contractions.
(1) Common sites. Sites of lacerations are the vaginal side wall, the cervix,
the lower uterine segment, and the perineum.
Degrees of perineal lacerations.
(a) First degree-tear of the vaginal and perineal mucous membranes.
(b) Second degree-tear of the vaginal and perineal mucous membrane
and the perineal muscles.