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The study, cocreated by Jack Stecher, MD, an anesthesiologist on the medical staff at BUMC, and Jamie Crowson, CRNA, investigated the use of cold temperatures to fight uterine atony, a condition that prevents the uterus from self-contracting.
Frequently bleeding was due to uterine atony secondary to prolonged labour, other causes being traumatic extensions of the uterine incision or placental site bleeding.
Following delivery, Natalie suffered from postpartum hemorrhaging and uterine atony, medically described as the failure of the uterus to contract after delivery.
In additional findings, a history of postpartum hemorrhage due to one etiology, for example, uterine atony or retained placenta, increased the risk not only of a recurrence of hemorrhage due to the same etiology but also of occurrence of hemorrhage due to other etiologies.
In a double-blind study Munn et al (19) compared two oxytocin infusion regimens to prevent uterine atony at caesarean delivery in labouring women.
Uterine balloon tamponade is better known for treatment of primary PPH from uterine atony or placenta praevia.
Unlike other maternal and fetal risk factors that predispose high-risk deliveries, such as abnormal placentation, which can frequently be identified by predelivery imaging and triaged accordingly, uterine atony does not have identifiable antepartum risk factors and cannot be identified before delivery--making it more difficult to detect and treat.
The investigators conclude that misoprostol is clinically equivalent due to uterine atony in women who have received oxytocin prophylactically during the third stage of labour, but that oxytocin is still the drug of choice.
Multiple gestations overdistend the uterus, and uterine atony may accompany pregnancies with twins or higher-order multiple gestations.
Active management of the third stage of labour consists of interventions designed to facilitate the delivery of the placenta by increasing uterine contractions and to prevent PPH by averting uterine atony.