Hypotonic and atonic bleeding

Bleeding observed in succession and in the first hours postpartum, due either to reduced ability or inability of uterine muscles to contract. Bleeding of the first kind is called hypotonic, and the second kind - atonic.
Usually a midwife has to deal with hypotonic hemorrhage: atopic bleeding is extremely rare (M. L. bath attendants, L. A. krivsky and others). However, even now many obstetricians-gynecologists (Imperial family Jordania, M. Century Mogilyov and other) incorrectly called hypotonic hemorrhage atonic.
Called "hypotonic hemorrhage" refers to bleeding from the uterus, caused by the reduction of the uterine tone, leading to a lack of contractions of muscle fibers and reservoirs, and at the same time a violation of the process of blood clots in the vessels placental site. In those cases, when there are unusual bleeding, uterine tone reduced so that its wall seems sluggish, stretched, as if paralyzed, not responding (or weakly reactive) on the mechanical, thermal and other irritants and medical facilities. Simultaneously, often broken blood coagulability. Untimely and improperly conducted measures under hypotonic and especially in atonic bleeding can be a cause of death of women.
With hypotonic hemorrhage in most cases, the doctor cope; if true (full) same uterine atony struggle for the life of the patient is often unsuccessful. In such cases are often not rescued even removal of the uterus, as to the operation resort is usually late, after the unsuccessful use of a whole Arsenal of tools and manuals.
Filed D. E. Morozovoi (materials of Sverdlovsk scientific research Institute of maternity and infancy), hypotonic hemorrhages occur in 10,91%. Blood loss in these cases varies from 600 to 1500 ml and often even in a large extent.
Hypotonic and atonic, the uterine muscles contrary to the state tonic stress, which is characteristic of a well-functioning uterus and is controlled by the neuro-hormonal mechanisms and the main governing and directing role of the cerebral cortex.
Razvijenosti in the work of the regulatory mechanisms that disrupts normal hormonal balance of the body. As a result of this shifts in proportions gonadotropic (hormonally gonadotropin and sex (estrogen and luteolin) hormones and receive qualitatively new factions of the latter. Meanwhile, found that using hormones nervous system carries out not only by their influence on the neuro-muscular system of the uterus, but regulates the condition of the cardiovascular and other systems of the body.
Here we must assume that with the hormonal balance is changing not only the functional condition of the uterus, manifesting itself in the form of hypotension or atony last, but also violated hemodynamics, which naturally leads to increased physiological blood loss in the sequence of the period known as the hypotonic hemorrhage.
Undoubtedly, in the development of hypotension and atonic bleeding is the fatigue factor, associated with the duration of birth and available obstetrical pathology, requiring a "surge" of the nervous system, especially in women undergoing in childbirth fear for the fate of the child and for themselves (negative emotions), and in cases when previous generations were pathological (trace reactions).
Therefore, of considerable importance in the manifestation of this pathology is the type of higher nervous activity inherent in the woman.
Shortcomings in the functional properties of the uterus in the first place caused by the peculiarities of its morphological structure, namely, the inadequacy of the development of net-fibrous and muscular tissue of the uterus (diseases and development anomalies, tumors), acquired pathological changes due to previously deferred inflammatory diseases or traumatic injury (development in the womb of the connective tissue in the muscle damage) and, finally, disorders of innervation (neronettrayicon processes, connected with the changes of the properties of the protein in muscle tissue).
All of these factors, which have just been mentioned, cannot but affect contractile and retractive function of the uterus and not to contribute to the development of hypotension last.
Undoubted importance in the development of hypotension and atonic bleeding have multiple births, large fruit size, etc., in which the uterus, overly stretched during pregnancy, can not after the birth of a fetus and vyhozhdeniya of the placenta is rapidly and completely identify energy resources, characteristic of functionally complete the uterus.
Factors predisposing to hypotension bleeding include growths of the uterus with related bodies resulting from surgery (vaginal or brunetoochka fixation of the uterus). Fusion prevent the contraction of the uterus, resulting in gaps vessels remain gaping. Therefore, you should avoid surgical fixation cancer in women who are of child-bearing age. Contribute to the manifestation of hypotension also available in the uterus fibromatous node.
In addition, some importance disease of the whole body, accompanied by violations of the functions of separate organs and systems (cardiovascular, endocrine, and so on). Thus, according to the PM, Urticina, hypotonic hemorrhage in patients with malaria was observed in 41%. Efficiency UNESCO-Stroganov considered hypotonic hemorrhage as a result toxemia pregnant as a special type of gestosis.

Thus, the etiology and pathogenesis of hypotonic hemorrhages very complex, but in all cases is the undisputed primary role of the nervous system as a regulatory mechanism.
To talk about hypotonic hemorrhage in the early postpartum period, unless excluded all other causes of blood loss (soft tissue breaks external genital parts of the vagina and cervix, the delay of the placenta or its parts, and so on).
As already mentioned, along with the weakening of contractile uterine activity, essential decrease clotting properties of blood. Must remember that every doctor leading the fight against hypotonic and especially atopic bleeding; in such cases, you must apply measures to strengthen the contractility of the uterus, and to increase clotting properties of blood.
A physician should never forget that often the most insignificant uterine bleeding in the postpartum period in the absence of proper attention and timely assistance can go into threatening. Therefore, it is necessary to take timely measures and vigorously combat the bleeding.
Unequal reaction of the woman to blood loss depends not only on the number of loose blood, but also on the speed of blood loss. With the rapid and extensive blood loss, usually sooner disturbed function of the Central nervous system, which results in significant disorders in the body, and if not immediately be made massive transfusion of blood, a woman will die from acute anemia. In those cases, when a blood transfusion are made in a timely manner, the woman's body copes with blood, and further prevents the development of anemia and postpartum infectious diseases.
Given the possibility of occurrence of those or other complications on the soil of former blood loss, you need to promptly take all necessary measures to minimize the number of loose blood in succession period. In this regard, should be treatment and prevention activities, primarily in respect of those women who have adverse obstetric anamnesis (later the onset of the first reg, excessive blood loss during menstruation, the presence of algomenorrhea primary infertility, etc), especially when there are concomitant anatomical changes of the uterus fibromyoma, and so on) or obstetric history (self-induced abortion, bleeding when former childbirth on the soil intimate attachment of the placenta or placental remnants, of placenta previa, and so on).
Equally should be considered pathology at present childbirth, namely prolonged confinement with a long discharge of amniotic fluid, childbirth large fetus, multiple births, polyhydramnios, etc., and also the psychosomatic condition of women (hypotension or hypertension, cardiovascular disease, and so on).
With the preventive purpose for 6-12 hours before the end of childbirth may be given vitamin K (menadione and other drugs), which increases the number of prothrombin in the blood, and thereby improves its clotting (M. N. Diacov), Chinese Magnolia vine (40 drops for reception inside, two times during childbirth: for the first time - when you open the throat of the cervix on three fingers, and the second time - with full disclosure throat - including contraindications).
The recognition. The weakness of contractile activity of the uterus is vague, stretched to the extreme. The contours of its hardly be defined through the abdominal coverings; in rare cases, palpation of the uterus is absolutely not possible. The capacity of the uterus grows; in the enlarged cavity becomes concentrated a large amount of liquid and blood clots. While the external bleeding may not exist or be insignificant. However, only a little squeeze hypotonic the uterus, as pours out copious amounts of liquid blood and excreted blood clots. After removal of blood uterus is usually well reduced. In some cases, despite remove the accumulated blood, uterus remains relaxed and bleeding progresses.
To recognize hypotonic hemorrhage in the early postpartum period easily. It is very abundant (broad stream) and begins soon after vyhozhdeniya of the placenta. Vagueness and lengthiness of the uterus, the difficulty or even impossibility to contribute through relaxing the abdominal wall, high standing of the fundus of the uterus (if possible to identify) are signs of hypotension uterus.