During childbirth, contractions are responsible for bringing the newborn baby into the world, but after birth, they continue with a different purpose: to contract the uterus so that the healing process of the female organ can begin. However, some mothers may experience a dysfunction called uterine atony.

It consists in the loss of the woman's ability to contract the uterus after delivery, which consequently increases the chances of postpartum hemorrhage (PPH). The condition can put the mother's life at risk, so much so that excessive blood loss is the leading cause of maternal mortality worldwide. In Brazil, it comes in second place, second only to hypertensive disorders.

"Postpartum hemorrhage can be defined as blood loss greater than 500 ml in the vaginal postpartum or greater than 1000 ml in the cesarean section. However, the most important thing to consider is that any blood loss capable of causing hemodynamic instability should be considered a case of major postpartum hemorrhage," guides the document "Key Issues in the Management of Postpartum HemorrhageChildbirth", from the Good Practices in Women's, Children's, and Adolescents' Health Portal, from the Ministry of Health and Oswaldo Cruz Foundation (FioCruz).

Read more: After all, what are the risks and precautions of pregnancy after 40?

The main causes of uterine atony

Before the baby is born, some conditions may be associated with a possible condition of uterine atony after the baby is born:

• Obesity;
• Women who will be mothers before they are 20 or after they are 40;
• Twin pregnancy;
• Fetal macrosomia (when the baby is larger than conventional)
• Polyhydramnios (excess amniotic fluid);
• Myomas in the uterus;
• Very long labor.

Add to this list also cases of women who had uterine atony in a previous pregnancy and may repeat the condition in the following ones.

Read more: A hard belly in pregnancy: What does it mean?

Prevention and recommended treatments

The World Health Organization (WHO) recommends the use of oxytocin from the third stage of labor, called dequitation, as a form of prevention against postpartum hemorrhage. If PPH occurs anyway, the next medical handling must be fast. For this, the maternity hospital needs a well-established standard protocol, as oriented by the document "Postpartum Hemorrhage", also fromPortal of Good Practices in Women's, Children's and Adolescent Health.

That said, the specialists' first action should be to compress the blood while the team prepares more oxytocin, which is a pharmacological agent capable of bringing tone to the uterus and increasing the contractions produced by the female organ.

If drug treatment fails, an intrauterine tamponade balloon is used, which, when inflated, forms a kind of barrier to the outflow of blood. This technique is estimated to reduce the need for surgical procedures by up to 60%.

In more serious situations, the medical orientation may be total hysterectomy. In summary, it is a surgery to remove the cervix and the female organ so that the doctors can completely stop the bleeding.

Sources: World Health Organization and Portal of Good Practices in Women's, Children's, and Adolescent Health, from the Ministry of Health and Oswaldo Cruz Foundation (FioCruz).