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Review
. 2022 Apr 1;34(2):82-89.
doi: 10.1097/GCO.0000000000000776.

Uterine atony

Hayley E Miller  1 , Jessica R Ansari  2
Affiliations
Review

Uterine atony

Hayley E Miller et al. Curr Opin Obstet Gynecol. .

Abstract

Purpose of review: Postpartum hemorrhage (PPH) is the leading preventable cause of maternal morbidity and mortality worldwide. Uterine atony is identified as the underlying etiology in up to 80% of PPH. This serves as a contemporary review of the epidemiology, risk factors, pathophysiology, and treatment of uterine atony.

Recent findings: Rates of postpartum hemorrhage continue to rise worldwide with the largest fraction attributed to uterine atony. A simple 0-10 numerical rating score for uterine tone was recently validated for use during cesarean delivery and may allow for more standardized assessment in clinical and research settings. The optimal prophylactic dose of oxytocin differs depending on the patient population, but less than 5 units and as low as a fraction of one unit is needed for PPH prevention, with an increased requirements within that range for cesarean birth, those on magnesium, and advanced maternal age. Carbetocin is an appropriate alternative to oxytocin. Misoprostol shows limited to no efficacy for uterine atony in recent studies. Several uncontrolled case studies demonstrate novel mechanical and surgical interventions for treating uterine atony.

Summary: There is a critical, unmet need for contemporary, controlled studies to address the increasing threat of atonic PPH.

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References

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    1. Liu C, Yu F, et al. Prevalence and risk factors of severe postpartum hemorrhage: a retrospective cohort study. BMC Pregnancy Childbirth 2021; 21:332.
    1. Committee on Practice Bulletins-Obstetrics. Practice Bulletin No. 183: Postpartum Hemorrhage. Obstet Gynecol 2017; 130:e168–e186.
    1. Xie Y, Liang J, Mu Y, et al. Incidence, trends and risk factors for obstetric massive blood transfusion in China from 2012 to 2019: an observational study. BMJ Open 2021; 11:e047983.

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