Uterine Atony

Uterine Hypotonicity Complications

Labor is strenuous on both the mother’s and baby’s bodies. OB-GYNs, nurses, and all other medical professionals must be prepared to treat any possible labor and delivery complications that arise in the process. However, maternal complications can also sometimes come after birth. One of those complications is uterine atony.

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Uterine atony occurs when the uterus fails to contract after delivery, and when left untreated, or insufficiently treated, it can cause excessive bleeding that threatens the mother’s life. Globally, it is one of the leading causes of maternal mortality.

Healthcare providers must understand and be alert to the signs of uterine atony and the methods for treating it. When they make negligent errors that worsen a mother’s injuries or result in her untimely death, it can constitute medical malpractice.

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Over the past three decades, the nationally recognized team of birth injury attorneys, registered nurses, and nurse-attorneys at Miller Weisbrod Olesky have established a proven track record of delivering justice for children and families across the United States who have suffered from all types of birth injuries, including maternal injuries from complications like uterine atony.

We are prepared to meticulously investigate the circumstances of your case, gather crucial medical records, consult with top medical experts, and fight tirelessly to secure the compensation you deserve for your child’s injury, all at no upfront cost to you.

We represent families and their children in numerous service areas throughout the United States. You can contact us today to Schedule your free legal consultation by calling our toll-free line at 888-987-0005 or by filling out our online request form. We work on a contingency fee basis, meaning you won’t pay any legal fees unless we win your case. We only receive payment once you do.

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What is Uterine Atony?

Uterine atony (also known as uterine hypotonicity) is a maternal complication where the mother’s uterus fails to contract after delivering the baby. While it can also affect contractions during childbirth, uterine atony primarily affects the afterbirth process.

The uterus is a hollow, muscular organ that holds and nourishes unborn babies. The organ itself has three layers:

• Endometrium –the inner, epithelial layer
• Myometrium – the smooth, muscle layer
• Perimetrium – the serosal outer surface of the uterus

The uterus naturally tightens (or contracts) during labor to force the baby out of her womb through the birth canal. The mother’s body should continue to stimulate mild contractions after the baby is born to deliver her placenta, a temporary organ that develops in the uterus during pregnancy to provide the fetus with blood, oxygen and nutrients.

After delivery, blood vessels in the uterus break open to allow the placenta to detach from the uterine lining. With uterine atony, the muscles of the myometrium soften and weaken to the point where they cannot compress those open blood vessels with contractions. This leaves the blood vessels exposed and results in vaginal bleeding known as postpartum hemorrhaging.

Uterine atony can happen in both vaginal births and C-section deliveries. It’s estimated to occur in around 2% of all deliveries in the United States.

Not all cases of atony result in postpartum hemorrhaging, but healthcare providers must be prepared for that possibility. If uterine atony does result in postpartum hemorrhaging, it is considered a medical emergency and requires immediate intervention.

What Causes Uterine Atony?

There can be multiple reasons why the uterus fails to contract both during labor and afterward. This can include uterine deformities and previous surgical procedures for injuries such as a uterine rupture. However, often there are more factors at play.

How Does Oxytocin Cause Uterine Atony?

The main cause of uterine atony is when the uterus does not adequately respond to the oxytocin hormone.

A woman’s body makes oxytocin throughout her lifetime, with increased production during pregnancy. As the fetus presses against her cervix, it triggers a nerve impulse that sends a message to the pituitary gland in her brain to produce more oxytocin. The oxytocin travels to her uterus to stimulate contractions.

Sometimes the mother may have a hormone imbalance that causes a deficiency in oxytocin, which will typically result in a prolonged or arrested labor. For women with these issues, their doctors may prescribe medications to induce labor. The most common is Pitocin, which is a synthesized version of oxytocin.

Doctors typically give Pitocin intravenously when inducing a woman whose labor has not started, but it is also given to women in labor whose contractions need to be strengthened for their labor to progress.

Pitocin can be effective in inducing labor, but the mother’s uterine muscle receptors can sometimes become desensitized to the chemical when too high of a dose is given for too long.

Or in other cases, too high of a dose for too long can overstimulate the uterus and cause contractions that are too frequent and too forceful (a condition known as uterine hyperstimulation). This can result in the uterus’s natural relaxation and re-contraction cycles being thrown off, which can weaken blood vessel compression after birth.

What are Risk Factors for Uterine Atony?

Other factors and characteristics of a mother’s pregnancy and labor can increase the risk for uterine atony, including:

• Uterine Overdistension: When the uterus is overdistended (meaning overly inflated or pushed out), it can weaken the effectiveness of contractions during labor and afterward.
  
  There can be numerous causes for this, including macrosomia (larger fetus than average), polyhydramnios (more amniotic fluid in womb than average), twin labor, uterine fibroids, or chorioamnionitis (a maternal infection of the amniotic fluid that can cause inflammation and swelling in the uterus.
• Prolonged or Spontaneous Labor: Labor that is either too long or too short can be a risk factor for uterine atony. Prolonged labor can indicate that a mother’s contractions are too weak to push out the child, which can foreshadow similar issues with delivering the placenta during afterbirth.
  
  Additionally, precipitous labor (labor lasting under three hours) can be a risk factor for atony because the uterus may not have enough time to properly contract and clamp the open blood vessels in the uterine wall post-delivery.
• Maternal Obesity: Expecting mothers with a BMI of 30 or higher are at an increased risk for pregnancy complications like gestational diabetes and preeclampsia. Doctors may prescribe a medication known as magnesium sulfate to manage these complications (particularly preeclampsia).
  
  Magnesium sulfate can inhibit muscle contraction, which can include affecting uterine contractions and increase her risk of experiencing atony.
• General Anesthesia: When general anesthesia is used on the mother during labor and delivery, the anesthetic agents may impact the uterine muscles and limit their ability to respond to hormones like oxytocin, increasing the risk of atony and postpartum hemorrhaging.

Other risk factors may include a mother’s previous history of experiencing uterine atony. Her healthcare provider must ask for her medical history and inquire about any complications from previous pregnancies to better understand her risk.

If an expecting mother exhibits two or more of these known risk factors, labor and delivery teams should make preparations and have a treatment plan ready in the event she experiences uterine atony. Failing to prepare where risk is clearly identifiable may be grounds for medical malpractice when it results in an injury.

The biggest sign of uterine atony is excessive bleeding coming from the uterus after delivery. While postpartum vaginal bleeding (discharge known as lochia) is normal, heavy bleeding typically indicates a larger issue. OB-GYNs and other present medical professionals should be able to tell the difference between bleeding that’s normal and bleeding that is cause for concern.

As the mother sustains significant blood loss, her blood pressure levels will also lower, and her heart rate will increase. Her healthcare providers should keep an eye on both metrics after delivery to monitor for any sudden drops or increases.

Visibly, the mother may begin to look pale and report feeling dizzy or faint. In cases of severe blood loss, she may even lose consciousness. Healthcare providers should also be alert if she discloses feeling any pain in her lower back or is unable to pee, as these symptoms are commonly reported in cases of uterine atony.

As illustrated above, the most concerning complication of uterine atony is postpartum hemorrhaging because of the threat it poses to the mother’s life. The American College of Obstetricians and Gynecologists listed postpartum hemorrhaging as one of the leading causes of maternal mortality and morbidity worldwide.

In some cases, postpartum hemorrhaging can cause anemia in mothers due to the loss of significant red blood cells.

Other blood disorders have been reported following cases of uterine atony in addition to anemia, such as hypovolemic shock and disseminated intravascular coagulation, a condition causing blood clots to form throughout the body.

Hypovolemic shock, while being a rare complication of uterine atony, can result from excessive blood loss and prevent sufficient oxygen flow to critical organs like the heart, liver, and kidneys.

This complication can be very dangerous for the mother, but it is only possible when more than 20% of her blood volume is lost. This is unlikely to occur in cases of uterine atony but is possible, especially in situations where medical professionals miss the early signs to intervene.

While these complications are all possible for a mother who’s experienced uterine atony, it’s important to note that most women end up making a full recovery. However, if a mother plans to have future pregnancies, she must be informed that her risk for uterine atony again is increased.

Healthcare providers can suspect uterine atony by tracking the mother’s blood loss after delivery. They may do this by weighing or keeping count of the number of pads and sponges they use to absorb her blood.

If the amount of blood loss is concerning, doctors will likely opt to perform a vaginal examination. The medical professional will place one hand on the mother’s abdomen and insert the other hand inside her vagina to feel the size and softness of her uterus.

Doctors will also examine the mother’s vagina, cervix and uterus to see if there are any tears or lacerations contributing to the blood loss. They will also check for any retained placental tissue.

This physical examination will be done alongside tracking the mother’s vital signs, including her heart rate and blood pressure. Doctors may order a series of blood tests to monitor her red blood cell count and blood clotting factor to check for any related complications like anemia or disseminated intravascular coagulation.

The immediate goal when managing a mother’s uterine atony is to stop the bleeding as fast as possible, and then to replace the lost blood and fluids. Doctors will need to apply pressure to the uterine walls to manually compress the blood vessels and stop the bleeding.

There are several ways to do this: they may decide to pack the mother’s uterus with medical gauze, or in more severe cases they can perform a medical procedure known as a balloon tamponade. This involves inserting a balloon into the mother’s uterus and then inflating it to maintain pressure against the uterine lining.

Administering medication is another possible treatment method. If not tried already, medical professionals may decide to administer Pitocin or Cytotec to induce contractions to deliver the placenta. Other medications, such as Methylergonovine, can be used to control uterine bleeding.

If these options are not possible or prove to be ineffective, doctors may need to perform surgery. There are a couple of different types of procedures to stop postpartum hemorrhaging, with the most common being uterine curettage. This involves scraping the retained blood and placental tissue from the uterus.

Uterine artery ligation is also sometimes performed to stop postpartum hemorrhage from uterine atony. This procedure involves tying off the blood vessels in the uterus to stop bleeding using surgical sutures.

If uterine curettage and artery ligation are not possible or ineffective, the “last resort” procedure is a hysterectomy, where the mother’s entire uterus is removed. This will eliminate the mother’s chances of future pregnancies, but doctors may deem it necessary if they cannot stop the bleeding and her life is at risk.

After the surgery is completed or the bleeding has been stopped another way, the mother will likely require IV fluids. If she has lost a significant amount of blood, a blood transfusion may be needed to supplement her low blood count.

Can Uterine Atony be Prevented?

No, there is no way to completely prevent a mother from experiencing uterine atony. However, healthcare providers can assess her risk using known information about her pregnancy and medical history.

They can prepare for possible medical intervention by having access to medications like Pitocin and having additional help and equipment in the room during delivery.

Uterine atony is a serious maternal complication that can have fatal outcomes, but the vast majority of mothers survive it and fully recover. However, this favorable prognosis is dependent on competent medical care. When birth injury medical negligence occurs, such as missing a risk factor for atony or making a surgical error when operating on the uterus, it can lead to preventable injuries for the mother and count as medical malpractice.

If a family believes medical negligence worsened a mother’s injuries or caused her death, legal support may be an option. A specialized birth injury malpractice attorney can review the medical records and circumstances to assess whether a claim exists.

Parents whose children suffer from the long-term effects of their mother’s mismanaged treatment for uterine atony, as well as mothers who were harmed after delivery from an untreated issue, deserve to know whether it could have been prevented. Our dedicated medical malpractice lawyers want to help you find those answers and obtain the funds necessary to improve the quality of life.

If you or your child has been diagnosed with an injury, and you suspect this may have been caused in part by medical mistakes, Miller Weisbrod Olesky will thoroughly investigate the facts and hold the responsible medical providers accountable by pursuing medical malpractice claims against them.

A statute of limitations (SOL) is a law that sets a time limit on how long an injured person has to file a lawsuit after an accident. It is essential to understand that statutes of limitations vary based on the type of case and the state where it is filed. For instance, the deadline for birth injury claims is typically different from other claims, such as injury to personal property, fraud, contract disputes, and collection of debts.

Generally, the clock starts ticking on the date the injury occurred. However, there are exceptions to this rule, and in some cases, the statute of limitations starts when a person discovers or reasonably should have discovered an injury. When dealing with government agencies, SOLs can become even more complex.

For example, if the party that injured you was:

• A federal employee
• Employed by a military hospital, Veterans Administration facility, or a federally funded medical entity

You may need to file a birth injury claim under the Federal Tort Claims Act (FTCA). In FTCA cases, claimants must go through certain administrative procedures before filing a lawsuit. In some states, if the negligent party was a local or state government hospital or the doctors and medical providers are employees of a governmental entity, the time period in which you must give "notice" may be shorter.

If your case is filed outside of the statute of limitations, it will typically be dismissed, and you will not be eligible to recover compensation for your injuries. Determining when a statute of limitations begins on your case can be tricky. If you're considering pursuing compensation for a birth injury, contacting an attorney as soon as possible is in your best interest.

Uterine atony is treatable and fully recoverable in many cases, but it takes a detailed expert review of the facts and circumstances of your delivery and the events that followed right after to determine whether the injury was the result of medical malpractice.

At Miller Weisbrod Olesky, a team of committed malpractice attorneys, nurses and paraprofessionals uses our detailed medical negligence case review process to assess your potential malpractice case. We start by learning more about your pregnancy by gathering medical records to determine what happened before, during, and after your delivery. We call in skilled medical experts who review your records and let us know if they think medical errors could have caused injury to you or your child.

If we feel medical negligence caused or contributed to your labor and delivery complications, we will meet with you to discuss how you can receive compensation from the medical professionals who made the errors.

At no point in our legal intake process will we ask you to pay anything. The medical review of your case and the consultation are free. We only receive payment when you do. The sooner you reach out to us, the sooner we can begin investigating your case and gathering the evidence needed to support your claim.

We work on a contingency fee basis, meaning you won't pay any legal fees unless we win your case. Contact us today to schedule your free consultation by calling our toll-free line at (888) 987-0005 or by filling out our online request form.