This occurs when parts of a child's place are trapped in the uterine cavity, the coagulation system is broken, traumas of the soft tissues of the birth canal are formed, and hypotension and atony of the uterus occur.
At a hypotension of a uterus the tone and ability of a uterus sharply decreases. Under the influence of various means and measures aimed at stimulating the contractile activity of the uterus, the muscles of the uterus begin to contract, although it sometimes happens that the force of the reduction reaction does not correspond to the force of the effect.
With atony of the uterus, the agents that activate the contractile activity of the uterus do not have any effect on it. The neuromuscular system of the uterus is in a state of paralysis. Atony of the uterus is quite a rare phenomenon, but it is accompanied by heavy bleeding.
The etiology of atonic and hypotonic bleeding is diverse and caused by various factors:
- depletion of the body and nervous system, as a result of painful and prolonged labor, persistent weakness of labor, oxytocin, rapid, rapid delivery;
- severe gestosis and hypertension;
- low attachment of the placenta and presentation;
- functional inferiority of the uterus - overgrowth of the uterus due to polyhydramnios, large fetus, multiple fetuses;
- anatomical inferiority of the uterus - underdevelopment and malformations of the uterus, scars on the uterus after surgery, uterine fibroids, past inflammatory diseases and abortions, which caused the replacement of a significant part of the connective muscular tissue of the uterus.
Atonic and hypotonic bleeding can also be caused by a complex of several of the above reasons. This will be the answer to why the uterus will not contract after giving birth right away and after a few hours.
In such a situation, bleeding can take a more serious character. Given the fact that atonic bleeding is very difficult to immediately distinguish from hypotonic, it is advisable to use a single term - hypotonic bleeding, and such a diagnosis as atony of the uterus should be set when all the measures performed were ineffective.
Clinical signs of hypotonic bleeding are expressed by the main symptom - profuse bleeding from the postpartum uterus, and this leads to other symptoms associated with hemodynamic disorders and acute anemia. There are signs of hemorrhagic shock.
The condition of the parturient woman depends on her general condition and on how long and intensive the bleeding is. The blood loss during childbirth should not exceed 0.5 percent of body weight, but not more than 450 milliliters. If the maternity body is exhausted, and the reactivity of the body is greatly reduced, then even a slight excess of the blood loss rate can lead to a severe clinical picture.
The intensity of the bleeding depends on the severity of the clinical picture. So, if there was a lot of blood loss - 1000 ml or more, for a long time, then the woman's body copes with this condition better than with rapid blood loss in the same or lesser volume, there is a risk of collapse and death.
The diagnosis of hypotension is established based on the symptom of uterine bleeding and the objective state of the uterus.
With hypotonic bleeding complex treatment is carried out without delay. At the same time, measures are taken to stop bleeding and replenish blood loss. All manipulations must be performed in a strictly defined order and aimed at increasing the contractility and tone of the uterus.
With a satisfactory condition of the parturient woman, to successfully reduce the uterus, it is necessary to apply the newborn to the breast in the first hour after birth. In the future, feeding should be frequent - every two hours during the daytime. When a child sucks a breast, stimulation of the hormone production of oxytocin occurs and this is the most effective means of contraction of the uterus. During the feeding of the baby, the uterus is actively contracting and because of this the woman may have pains in the lower abdomen, which feel similar to the contractions. In order for the uterus to contract, in the first days after childbirth, ice should be applied for 30 minutes and more often lie on the stomach. It is advisable to conduct preventive treatment with herbs, starting with the fourth for postpartum. For these purposes, you can use nettle grass, birch leaves, yarrow and grass shepherd's bags. Or, alternatively, use a mixture of herbs to prepare a decoction.
It is not recommended to engage in active physical exercises for tightening the abdominal press, since a strong impact on the uterus and other abdominal organs that have not yet taken their original location can lead to an inflammatory process and cause an incorrect arrangement of the organs.
As the uterus contracts, then during the first time after childbirth, abundant blood allocation is released from it - lochia. When you change the position of the body and when a woman rises, these secretions can intensify. Gradually they become light, then pale pink, and then stop six weeks after birth. To accelerate the healing process and to maintain hygiene purity, it is necessary to carefully process the external genitalia. Wash three times a day should be ended by washing away from the decoction of chamomile or oak bark. If there are seams, then after washing, they must be treated additionally with healing agents. Linen should only be made from natural fabrics.
It is very important to start the process of full-fledged breastfeeding from the first days. The normal lactation process contributes to the normalization of the hormonal background of the female body, and the postpartum recovery period will be more successful. To better restore strength and maintain immunity, a woman can take rose hips in the form of syrup, infusion or in the form of compote.