Overview
Atony of the uterus, characterized by inadequate uterine contractions, can lead to severe postpartum hemorrhage unresponsive to conventional uterotonic agents. 1Diagnosis
Persistent uterine bleeding post-delivery despite administration of standard uterotonic agents.
Absence of palpable uterine muscle tone.
Hemodynamic instability may indicate severity.Management
First-line treatments: Conventional uterotonic agents (e.g., oxytocin, ergometrine).
Adjunctive treatments: Intramyometrial injection of prostaglandin F2 alpha (PGF2α) in doses of 1-2 mg can be effective. Administered transabdominally, transvaginally, or intraabdominally during cesarean section. 1Special Populations
Pregnancy: Intramyometrial PGF2α injection is noted in cesarean sections but not specifically detailed for vaginal deliveries. 1Key Recommendations
Consider intramyometrial injection of prostaglandin F2 alpha (1-2 mg) for severe hemorrhage due to uterine atony unresponsive to conventional treatments. (Evidence: Moderate) 1
Monitor closely for potential side effects, particularly intravascular injection risks. (Evidence: Weak) 1References
1 Vincenti E, Tambuscio B, Marchesoni D, Graziottin A, Di Lenardo L, Chiaranda M. Use of intramyometrial injection of prostaglandin F 2 alpha in the management of intractable hemorrhage due to uterine atony. Clinical and experimental obstetrics & gynecology 1982. link