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Atonic uterus.. midwifery care plan lihay aahe

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"uterine atony" AND postpartum hemorrhage

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WHO postpartum haemorrhage uterine atony treatment recommendations

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Midwifery Care Plan: Atonic Uterus

Definition: Atonic uterus means the uterus fails to contract effectively after delivery. It becomes soft or “boggy,” causing postpartum haemorrhage (PPH) because the uterine muscle does not compress the placental-site blood vessels. Uterine atony is the commonest cause of primary PPH. ROSEN's Emergency Medicine, p. 3420.
Emergency: Treat ongoing postpartum bleeding with a boggy uterus as PPH. Call the obstetric emergency team immediately and follow the hospital PPH protocol.
AssessmentMidwifery/Nursing DiagnosisGoals/Expected outcomesMidwifery interventionsRationale
Heavy vaginal bleeding, clots, uterus soft/boggy and poorly contracted, fundus high, tachycardia, low BP, pallor, dizziness, restlessness, reduced urine output.Postpartum haemorrhage related to uterine atony as evidenced by excessive vaginal blood loss and boggy uterus.Bleeding reduces, uterus becomes firm and central, vital signs remain stable, shock is prevented.1. Call for help immediately: senior midwife, obstetrician, anaesthetist and blood bank as per protocol.

2. Perform immediate fundal/uterine massage; assess uterine tone regularly.

3. Empty the bladder. Insert urinary catheter if indicated and monitor hourly urine output.

4. Assess and quantify blood loss, check pads/linen and clots. Do not underestimate blood loss.

5. Check for the “4 Ts”: Tone (atony), Trauma (tear), Tissue (retained placenta), Thrombin (coagulopathy).

6. Maintain IV access with two large-bore cannulas; send blood for CBC/Hb, group and cross-match, coagulation profile as ordered.

7. Start warmed IV fluids and prepare blood/blood products as prescribed.

8. Administer uterotonics and tranexamic acid promptly as prescribed and according to local PPH protocol.

9. Prepare for bimanual uterine compression, balloon tamponade, theatre or surgery if bleeding continues.

10. Monitor pulse, BP, respiration, SpO₂, consciousness, skin colour and urine output frequently.		Uterine massage stimulates uterine contraction. An empty bladder allows the uterus to contract properly. Accurate blood-loss assessment and early escalation reduce delay in treatment. IV fluids and blood replacement prevent/treat hypovolaemic shock. WHO first-line PPH care includes uterine massage, an oxytocic agent, tranexamic acid, IV fluids, genital-tract examination and escalation of care. WHO PPH guideline
Fear, anxiety, crying, confusion due to bleeding and emergency procedures.Anxiety related to emergency condition and fear of maternal complications.Mother verbalizes reduced fear and cooperates with treatment.1. Remain with the woman; speak calmly and clearly.
2. Explain procedures briefly, such as massage, IV line, medicines and possible transfer to theatre.
3. Allow a support person to remain if safe and feasible.
4. Reassure her while avoiding false reassurance.		Clear communication and continuous support reduce anxiety and promote cooperation.
Risk of hypotension, poor perfusion and hypovolaemic shock due to blood loss.Risk for deficient fluid volume/shock related to acute postpartum blood loss.BP and pulse remain within acceptable range; urine output is at least 30 mL/hour; woman remains alert.1. Lay woman flat, keep warm and provide oxygen if indicated.
2. Monitor observations every 5-15 minutes during active bleeding.
3. Record all IV fluids, blood products, blood loss and urine output on the PPH chart.
4. Escalate immediately if bleeding persists, pulse rises, BP falls, or consciousness changes.		Pregnancy may mask shock until substantial blood loss has occurred. Close monitoring identifies deterioration early. ROSEN's Emergency Medicine, p. 3420.
Need for prevention of recurrence and complications after control of bleeding.Knowledge deficit related to postpartum warning signs and follow-up care.Mother understands warning signs and follow-up before discharge.1. Continue checking fundal tone, lochia and vital signs after bleeding is controlled.
2. Encourage breastfeeding/skin-to-skin if mother and baby are stable, as endogenous oxytocin supports uterine contraction.
3. Teach danger signs: soaking a pad in less than an hour, passage of large clots, faintness, palpitations, fever, foul-smelling lochia or increasing abdominal pain.
4. Ensure Hb assessment, iron therapy/nutrition advice and follow-up as ordered.
5. Document event, estimated blood loss, interventions, medicines, response and handover.		Continued surveillance detects recurrent PPH. Education supports timely return for emergency care.

Risk factors to assess

  • Overdistended uterus: multiple pregnancy, polyhydramnios, macrosomic baby
  • Prolonged or induced labour
  • Chorioamnionitis
  • Previous PPH or uterine atony
  • Tocolytic drugs or uterine-relaxing general anaesthesia
  • Retained placenta or placenta-related disorders
A soft, boggy uterus with excessive bleeding supports uterine atony, but genital tract trauma and retained placental tissue must also be excluded. ROSEN's Emergency Medicine, p. 3420.

Evaluation

Care is effective if:
  • Uterus is firm, contracted and midline
  • Vaginal bleeding is minimal and no large clots are present
  • Pulse, BP, consciousness and urine output are stable
  • No further escalation or surgical intervention is required
  • Mother understands postnatal warning signs
Evidence update: A 2025 systematic review found multiple causes and risk factors contribute to PPH, supporting a structured assessment rather than assuming atony alone (PMID 40188841).

Mi pathvte tya format madhe

Format पाठवा. त्याच format मध्ये atonic uterus ची midwifery care plan लिहून देते.
analyse_media
हा format समजला. Atonic uterus / Postpartum haemorrhage साठी मी याच handwriting-file style मध्ये खालील headings ठेवून लिहीन:
  1. Identification Data
  2. Present History of Illness
  3. Past History
  4. Menstrual History
  5. Obstetric History
  6. Family History
  7. Personal History
  8. Physical Examination
  9. Systemic Examination
  10. Investigations
  11. Medical Management
  12. Nursing Care Plan
  13. Health Education
  14. Conclusion
तुम्ही पुढचे format चे pages पाठवा, especially nursing care plan table वाला page. मग त्याच exact format मध्ये पूर्ण लिहून देते.

Mi पाठवलेल्या format nusar de

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IDENTIFICATION DATA

Patient Name - Mrs. XYZ
Age - 24 years
Doctor’s Unit - Obstetric and Gynaecology Unit
Register No. - __________
Education - __________
Occupation - Housewife
Income - __________
Religion - Hindu
Marital Status - Married
Duration of Marriage - 2 years
Blood Group - B Positive
Diagnosis - Postpartum haemorrhage due to Atonic Uterus

PRESENT HISTORY OF ILLNESS

Mrs. XYZ, 24 years old, was admitted in obstetric ward with the complaint of excessive bleeding per vagina after delivery.
  • Patient delivered a full-term baby by normal vaginal delivery.
  • After delivery of placenta, patient had excessive bleeding per vagina with passage of blood clots.
  • Uterus was soft, boggy and not well contracted on palpation.
  • Patient complained of weakness, dizziness and palpitations.
  • On examination, pulse rate was increased and blood pressure was low.
  • There was no history of retained placenta or genital tract injury.
  • Hence, patient was diagnosed as a case of postpartum haemorrhage due to atonic uterus.

PAST HISTORY

  • No history of hypertension.
  • No history of diabetes mellitus.
  • No history of tuberculosis, asthma or heart disease.
  • No previous history of surgery.
  • No known allergy to any medication.
  • No previous history of postpartum haemorrhage.

MENSTRUAL HISTORY

Age of Menarche - 13 years
Menstrual Cycle - Regular
Duration of Flow - 3-4 days
Interval - 28-30 days
Amount of Flow - Moderate
Dysmenorrhoea - Absent
LMP - __________
EDD - __________

OBSTETRIC HISTORY

Gravida - G1
Para - P1
Living - L1
Abortions - A0
YearAntenatal periodIntranatal periodPostnatal periodBaby
Present pregnancyRegular ANC takenFull-term normal vaginal deliveryExcessive bleeding after delivery due to atonic uterusLive baby, crying at birth

FAMILY HISTORY

  • Type of family - Nuclear family
  • Number of family members - __________
  • No family history of hypertension, diabetes mellitus, tuberculosis, bleeding disorder or hereditary disease.

PERSONAL HISTORY

Diet - Mixed diet
Appetite - Reduced after delivery
Sleep - Disturbed
Bowel Habits - Regular
Bladder Habits - Catheterized/monitored
Addiction - No history of tobacco, alcohol or smoking
Allergy - No known allergy

PHYSICAL EXAMINATION

General condition - Conscious, weak and anxious
Built - Moderate
Nourishment - Moderate
Pallor - Present
Icterus - Absent
Cyanosis - Absent
Clubbing - Absent
Oedema - Absent
Lymph nodes - Not palpable

Vital Signs

Temperature - 98.4°F
Pulse - 110/minute, rapid
Respiration - 24/minute
Blood Pressure - 90/60 mmHg
SpO₂ - 98% on room air

ABDOMINAL EXAMINATION

  • Abdomen is soft.
  • Fundus is not well contracted.
  • Uterus is soft and boggy on palpation.
  • Fundal height is higher than expected for immediate post-delivery period.
  • Excessive vaginal bleeding is present.
  • Bladder may be distended.

LOCAL EXAMINATION

  • Excessive bleeding per vagina present.
  • Blood clots may be present.
  • Placenta and membranes checked for completeness.
  • Birth canal examined to rule out cervical, vaginal and perineal tears.

INVESTIGATIONS

  • Complete blood count
  • Haemoglobin percentage
  • Blood group and cross-matching
  • Coagulation profile
  • Platelet count
  • Urine routine examination
  • Blood sugar level, if ordered

MEDICAL MANAGEMENT

  • Uterine massage done immediately.
  • IV line secured with large-bore cannula.
  • IV fluids started as prescribed.
  • Oxytocin given as prescribed.
  • Other uterotonics given according to doctor’s order and contraindications.
  • Tranexamic acid administered as prescribed.
  • Blood sample sent for grouping, cross-matching and Hb.
  • Blood/blood products arranged if required.
  • Foley’s catheter inserted and urine output monitored.
  • Bimanual uterine compression and balloon tamponade prepared if bleeding persists.
  • Obstetrician and anaesthetist informed.
Note: Atonic uterus is an obstetric emergency. Uterine massage, uterotonic drugs, tranexamic acid, IV fluids, examination for trauma/retained tissue and rapid escalation are part of first-line PPH management.
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