Recall Exercise: Uterine Atony Answer Key

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Answers:

What is Uterine Atony?

↱  Failure of the uterus to remain contracted after giving birth.  Normal contraction compresses blood vessels and prevents bleeding.  ↲

What can cause this condition?

→  Infrequent urination.
→ Infection of the lining of the uterus.

→ Retained placenta, or fragments.

What happens if uterine atony is left untreated?

↱ After the placenta leaves the body, there are a lot of bleeding blood vessels where it was attached.  Left uncompressed, these vessels will hemorrhage, which puts the woman at risk for hypovolemic shock.  ↲

How are some signs and symptoms of uterine atony?

→ Watch for falling blood pressure and increased heart rate.

→  Assess lochia (vaginal drainage) for large clots or excessive bleeding.

→  The patient may complain of pain or back ache.

 How do nurses assess for uterine atony?

↱  Uterine atony can be detected by gently pressing in and down near the umbilicus.  The top of the uterus is called the fundus.  It should feel firm.  ↲ 

What can nurses do to treat uterine atony?

↱ There are a few options.  The first line treatment is performance of fundal massage.  This involves kneading the abdomen.  It is not unusual for some bleeding to occur during the procedure, but it should stop after a few minutes.  An assessment of the fundus should reveal a firm uterus, if the procedure was successful.  ↲

What happens after uterine atony is discovered and treated?

↱  The nurse should reassess every half hour, because it can reoccur.  If it keeps happening, the provider should be notified.  ↲

What medication is administered if fundal massage is an insufficient treatment?

↱  A provider will often administer a drug called Methergine (methylergonovine maleate).  This drug causes the uterine muscles to contract.   It is vasoconstrictive, so it will help stop bleeding.  ↲

Why would a provider order an ultrasound in response to recurrent uterine atony?

↱  To see if any placenta is retained in the uterus.  This would prevent the uterus from contracting properly.  ↲

Why might a provider prescribe antibiotics for uterine atony?

↱ Some people who are group beta strep positive develop endometritis, which is an infection of the uterine lining.  This can cause uterine atony.  Eliminating the infection will allow the uterus to contract properly.   ↲

What are some signs and symptoms of an infection-based uterine atony?

→ Fundal soreness

→ Odor of vaginal discharge

→ Fever

By what two routes is Methergine administered?

↱  Initially, the doctor may give an IM injection to get a quick result.  After the patient is stable, the doctor may switch them to an oral form.  This medication is rarely administered IV, because it causes severe hypertension and increased risk of stroke.  In rare situations it is used in emergencies, when benefit outweighs risk.  ↲

Is Methergine ever used to jump start labor?

↱  No.

Methergine is never administered before a baby is born.  It can cause long, severe contractions that endanger mother and baby.  ↲

What assessments should be performed when someone is taking Methergine?

→  The nurse should watch blood pressure for signs of hypertension.  

→  Be watchful for signs of stroke.

→  Assess uterine firmness, fundal height and amount of lochia (discharge), to determine medication effectiveness.

What are signs of Methergine toxicity?

→  Headache

→  Chest or Muscle Pain

→  Systemic weakness

→  Tingling of the extremities

→  Cold fingers or toes

→  Nausea