How to deal with uterine atony?
summary
How to deal with uterine atony? Whether it is primary or secondary, when there is coordinated uterine atony, we should first find out the cause, whether there is cephalopelvic disproportion and abnormal fetal position, and understand the cervical dilatation and decline of fetal presentation. If there is cephalopelvic disproportion and it is estimated that it can not be delivered through vagina, cesarean section should be performed in time. If there is no cephalopelvic disproportion and abnormal fetal position and it is estimated that it can be delivered through vagina, measures to strengthen uterine contraction should be considered. So the treatment of uterine atony?
How to deal with uterine atony?
The first stage of labor 1) general treatment: eliminate mental tension, more rest, encourage more eating. Those who can't eat can be supplemented with vitamin C 2G in 500-1000ml Deng 10% glucose solution. 5% sodium bicarbonate should be added when accompanied with acidosis. In hypokalemia, potassium chloride should be given slowly by intravenous drip. Maternal fatigue, can be given diazepam 10mg slow intravenous injection or pethidine 100mg intramuscular injection, after a period of time, can make uterine contractility stronger. For the primipara whose cervix is less than 3cm and fetal membrane is not broken, warm soapy water enema should be given to promote intestinal peristalsis, eliminate feces and pneumatosis, and stimulate uterine contraction. If it is difficult to urinate naturally, the induction method should be used first. If it is invalid, catheterization should be used, because emptying the bladder can widen the birth canal and promote uterine contraction.
Artificial rupture of membrane: artificial rupture of membrane is feasible when cervical dilatation is 3cm or more, there is no cephalopelvic disproportion, and the fetal head has been connected. After rupture of membranes, the fetal head directly clings to the lower uterine segment and cervix, causing reflex uterine contraction and accelerating the progress of labor. The existing scholars advocate that artificial rupture of the fetal head is also feasible for those who do not connect the fetal head, and believe that the rupture of the fetal head can promote the descent of the fetal head into the basin. When breaking the membrane, we must check whether the umbilical cord is exposed first. Breaking the membrane should be carried out in the interval of uterine contraction. After rupture of the membrane, the operator's fingers should stay in the vagina. After 1-2 contractions, the operator should take out the fingers after the fetal head enters the basin. Bishop proposed to use cervical maturity score method to estimate the effect of strengthening uterine contraction measures, as shown in Table 1. If the parturient's score is below 3 and the artificial rupture of membrane fails, other methods should be used. The success rate of 4-6 points was about 50%, that of 7-9 points was about 80%, and that of more than 9 points was all successful.
In the process of oxytocin intravenous drip, special personnel should be assigned to observe uterine contraction, listen to fetal heart rate and measure blood pressure. If uterine contraction lasts more than 1 minute or fetal heart rate changes, infusion should be stopped immediately. The half-life of oxytocin in maternal blood is 2-3 minutes. It can improve rapidly after withdrawal. If necessary, sedatives can be added to inhibit its effect. If the blood pressure is increased, the infusion speed should be slowed down. Because oxytocin has antidiuretic effect, the reabsorption of water increases, and there may be less urine. Therefore, we should be alert to the occurrence of water poisoning.
matters needing attention
The treatment principle of uncoordinated uterine atony is to regulate uterine contraction and restore the polarity of uterine contraction. Give strong sedative pethidine 100mg or morphine 10 ~ 15mg intramuscular injection, make puerpera rest fully, after waking up, more can return to coordinated uterine contraction. Oxytocin is strictly prohibited until the uterine contraction is restored to coordination. If the above treatment, uncoordinated uterine contractions can not be corrected, or accompanied by fetal distress signs, or accompanied by cephalopelvic disproportion, cesarean section should be performed. If the uncoordinated uterine contraction has been controlled, but the uterine contraction is still weak, we can use the method of strengthening the uterine contraction when the coordinated uterine contraction is weak.
