articles bleeding relationship with atonia uteri

CHAPTER I
INTRODUCTION
A. Background
As a melatarbelakangi this paper is to discuss about " atonia Uteri " is so we can
find out what the atonia uteri and how codes of the atonia uteri . This paper is
made so that students understand more about the meaning , causes, and ways
of handling atonia uteri .
Atonia uteri was the cause of most childhood pospartum bleeding ( 50 % ) , and
is the most frequent reason for doing a hysterectomy postpartum . Contractions
of the uterus is the primary mechanism to control bleeding after childbirth .
Atonia occurred because of failure of this mechanism . Pospartum physiologic
bleeding is controlled by fiber - fiber contractions of the myometrium
surrounding the blood vessels of the placenta implantation memvaskularisasi
district . Atonia uteri occurs when the fiber - fiber non- contracting myometrium
Uteri atonia is a condition in which the myometrium can not contracting and
when this happens the blood coming out of the container to attach the placenta
becomes uncontrolled . ( Apri , 2007).
B. Summary of Problems
1 . Explaining the meaning of atonia uteri
2 . Factor explaining the cause of the atonia uteri
3 . explain the occurrence of signs and symptoms of atonia uteri
4 . Explaining how it handles or codes of atonia uteri
C. Purpose of Writing
1 . Knowing and understanding about atonia uteri
2 . Adding knowledge of atonia uteri
3 . Get to know about the meaning , etiology , factors cause , and also codes of
atonia uteri .

CHAPTER II
DISCUSSION
2.1 Atonia understanding uteri
Uterine atony is defined as a condition in the failure of the uterus to contract properly after
delivery , whereas atonic uterus is also defined as the absence of uterine contractions
immediately after delivery of the placenta .
Most of the bleeding in the puerperium ( 75-80 % ) is due to uterine atony . As we know that
uteroplacental blood flow during pregnancy is 500-800 ml / min , so we can imagine that
when the uterus does not contract for a few minutes, it will cause the loss of so much blood .
While the human blood volume is only about 5-6 liters .
2.2 . Factors Causing Occurrence of uterine atony

Several factors associated with predisposition postpartum hemorrhage caused by uterine

atony , which are:
1 . Enlarged uterus more than normal during pregnancy , including :
excessive amount of amniotic fluid ( Polyhydramnios )
Pregnancy Gemelli
large fetus ( macrosomia )
2 . Stage one or stage two elongated
3 . Fast delivery ( parturition Precipitate )
4 . Labor induced or accelerated by oxytocin
5 . intrapartum infection
6 . high multiparity
7 . Magnesium sulfate is used to control seizures in preeclampsia
or eclampsia .
8 . age is too old or too young ( < 20 years and > 35 years )
Uterine atony can also arise due to incorrect handling of third stage of labor , by massaging
the uterus and push it down in an attempt to deliver the placenta , was in fact not be separated
from the uterus
2.3 The signs and symptoms of uterine atony
Signs and symptoms of uterine atony are :
vaginal bleeding
Bleeding that occurs in very many cases of uterine atony and blood does not seep . What
often happens is that the blood clot out with , this happens because the thromboplastin is no
longer as an anti- blood clotting .
Consistency soft uterus
This phenomenon is an important symptom / characteristic that distinguishes atonia atonia
and with other causes of bleeding .
Fundus ride
Caused by blood trapped in the uterine cavity and agglomerate
There are signs of shock
Low blood pressure , rapid pulse and a small , cold extremities , restlessness , nausea and
others.

2.4 Management Measures Atonia uteri

The amount of blood lost will affect the patient's general condition . Patients in the
circumstances could still conscious , slightly anemic , or until severe hypovolemic shock .
The first action that should be performed depending on the clinical circumstances .
NO step management of Reason
1 Massage fundus immediately after the birth of the placenta ( maximum 15 seconds )

Massage stimulates uterine contractions . When do penilaia dimasase uterine contractions

2 Clean the blood clot adan vaginadan pit membranes of the cervix

Blood clots and membranes in the vagina and cervical canal will be able to block both uterine
contractions .
3 Make sure that the bladder is empty , if fully palpable , do catheterization using aseptic
technique full bladder will be able block the uterus to contract properly .
4 Perform bimanual Internal ( KBI ) for 5 min internal bimanual compression gives direct
pressure on blood vessel walls uterusdan also stimulates the myometrium to contract .
5 Encourage the family to begin to help the family of external bimanual compression can
forward an external bimanual compression during helper do the next steps
6 Remove hand slowly Avoiding pain
7 Give ergometrin 0.2 mg IM ( contraindicated hypertension ) or 600-1000 mcg misopostrol
Ergometrine and misopostrol will work in 5-7 minutes and causes uterine contractions
8 Replace infusion using a needle 16 or 18 and give 500cc Ringer's lactate + 20 units of
oxytocin . Spend the first 500 cc ASAP large needles allow rapid administration of IV
solution or blood transfusion . RL will help restore the volume of fluid lost during
perdarahan.oksitosin IV will quickly stimulate uterine contractions .
9 Repeat KBI internal bimanual compression is performed in conjunction with oxytocin or
misopostrol ergometrin and will make the uterus contract
10 Refer immediately if the uterus is not berkontaksiselama 1 to 2 minutes , it is not a simple
atony . Mothers needing emergency treatment at a facility that is able to carry out the surgery
and blood transfusion
11 Facilitate the mother to the place of reference . Continue doing this uterine compression
KBI indirectly put pressure on the blood vessel walls of the uterus and stimulate the uterus to
contract
Continue +20 12 IU oxytocin infusion RL in 500 cc of solution at a rate of 500 cc / hour so
spent 1.5 I infusion . Then give 125 cc / hour . If there is not enough liquid , give 500 cc of
the latter at a moderate pace and provide drink for rehydration RL can help restore fluid
volume lost due to bleeding . Oxytocin can stimulate the uterus to contract .