How to avoid uterine atony during caesarean section

Preventing uterine atony after caesarean section requires standardized prenatal management, precise intraoperative operation, and postpartum monitoring and intervention.

1.Prenatal assessment

Improve screening for pregnancy complications, focusing on high-risk factors such as multiple pregnancy, polyhydramnios, and macrosomia. Use ultrasound to evaluate the placental position and uterine shape, and make plans in advance for conditions such as placenta previa and uterine malformations that may affect uterine contractions. It is recommended to reasonably supplement iron during pregnancy to prevent anemia and maintain hemoglobin >110g/L.

2. Anesthesia Management

During neuraxial anesthesia, control the anesthesia level below T6 to avoid excessive use of drugs that inhibit uterine contraction. For those with high-risk factors for postpartum hemorrhage, the combination of epidural patient-controlled analgesia and intravenous pumping of oxytocin can be considered to ensure the analgesic effect and reduce uterine contraction suppression.

3. Surgical operation

A transverse incision in the lower uterine segment is used to reduce muscle layer damage, and precise suturing is performed to avoid leaving dead space. Immediately after the delivery of the fetus, 10 U of oxytocin is injected into the uterus. After the placenta is delivered, the uterine cavity is systematically checked, and bimanual uterine massage is performed if necessary. Pay attention to gentle operation to reduce unnecessary exploration of the uterine cavity.

4. Drug prevention

In addition to the routine use of oxytocin, high-risk pregnant women can be combined with carboprost trometamol injection 250 μg for intrauterine injection or misoprostol tablets 600 μg for rectal administration. It should be noted that prostaglandin drugs are prohibited for those with a history of asthma and glaucoma.

5. Postpartum monitoring

Within 2 hours after surgery, the fundal height, vaginal bleeding volume and vital signs were monitored every 15 minutes, and the postpartum hemorrhage risk assessment form was used for dynamic assessment. When uterine atony is discovered, the treatment process is immediately initiated: bladder emptying, continuous uterine massage, intravenous infusion of oxytocin 20U + 500ml normal saline, and uterine cavity balloon compression if necessary.

It is recommended that mothers have skin-to-skin contact with their infants in the early postoperative period to promote endogenous oxytocin secretion, and monitor uterine contractions every 4 hours for 24 hours. Appropriately increase warm and tonic foods such as red dates and wolfberry porridge in your diet to avoid raw and cold stimulation. Encourage getting out of bed as soon as possible, but avoid lifting heavy objects and other behaviors that increase abdominal pressure. If sudden heavy bleeding or persistent abdominal pain occurs, please notify medical staff immediately.