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Atonia Uteri (The uterus does not contract)

by. Admin
17 July 2017
Atonia Uteri (The uterus does not contract)

Bismillah

On this occasion we are abducting Atonia Uteri. I am not interested in this subject because I think there are many who understand even the layman though. But what's so wrong if we refresh and update the information. In addition triggered by the contents of other articles that I think the content is less complete and full of fear mongering related medical conditions and choice of delivery. And more sadly, my response to mothers who experience excessive symptoms without wanting to know the physiological phases and conditions of actual labor.

Atonia uteri is the failure of the womb to contract legally after birth (caningham, 2013: 415). After delivery of a baby or placenta, the uterus will contract which will bind the open blood vessels of placental implantation. If the uterus does not contract strongly enough or atony uteri then this open blood will free the blood and bleeding. This uterine atonia is associated with the incidence of Post Partum Hemorhage (PPH) / (HPP) Bleeding Postpartum (loss of blood> 500 ml) and this is the case with the mother. Here I will quote an important point from the article of health personnel who last day had appeared on my porch.

1. Atonia uteri can not be prevented and can happen to anyone.

Is that right?

Allah is the Most Intelligent, so powerful that it can create everything and its signs. Both in terms of medical and disease. Humans if cough and runny nose are given a sign of sneezing at least more than 3x, get sick with a weak body marks or fever, there is infection in the body (whatever) is given a hot mark first, etc .. That's all a small sample of the signal from Allah SWT directly for us. Is not that a sign of His greatness? Similarly, uterine atony can be avoided through screening of patients at delivery. Screening of patients with potentially uterine atony is anemia (lack of hemoglobin), patients with low nutritional status, previous history or labor, multiple pregnancies (twins), and large infants. To avoid the occurrence of postpartum hemorrhage we must recognize the key to success, namely:

# Nutrition and Supplements are good as needed

By consuming foods and natural supplements rich in nutrients especially to increase the production of red blood cells, accelerate cell regeneration and remove toxins / toxins in the body will prevent us from the risk of anemia. Example: consumption of liquid chlorophyll, dates, raspberries, grains, nettles, etc.

# Getting more info about mother's health

If there is a mother who shows screening data that refers to the risk of uterine atony, the need for laboratory investigation checks hemoglobin (Hb), Hematrokit and platelets to determine normal blood clots in the mother's body.

# For health workers - Not in a hurry to give birth to the placenta

Almost all postpartum hemorrhage is caused in a hurry in delivery of the placenta. At the time of space in the muscle The uterus has not had a chance to contract in helping control the blood flow, at that time the uterine overmanipulation occurs from the hasty labor companion to give birth to the placenta. This causes the remaining part of the placenta that is still attached to the wall of the uterus causing an uneven contraction and then there was bleeding.

The study mentions many medical personnel who do not allow time for placenta to be born naturally. Postpartum haemorrhage may be avoidable if medical practitioners do not intervene and override the birth of the placenta.

In a medical standpoint, a significant 68% reduction in HPP is found in 3-week active management involving uterotonic administration (ex: oxytocin) with or shortly after birth, controlled controlled tension can shorten the time of delivery of the placenta with no significant increase in risk Retention of the placenta (placenta difficult birth). This is compared to letting the placenta be born naturally only with the position of gravity and nipple stimulation.

Back to the belief that Allah SWT creates the time of birth of a baby or placenta can vary every woman. I once had a home birth patient with a history of first child labor in the hospital with a prolonged birth of the placenta until forced expulsion by midwife hands led to trauma, then second and third children through my accompaniment with a placenta we waited for 1, 5 hours that finally came out Naturally without bleeding and also without uterotonic administration (oxytosin).

2. Handling of uterine atony quickly can only be in hospital

Reasons for remote reference places? Okay for remote areas that pass through winding mountains and sea with waves wrestling. Prediction of maternal mortality due to bleeding in just 1 hour. For today, especially for mothers who live in big cities, the location of the hospital can even a few hundred meters from the house. There was even my patient whose home was right in front of the cesarean referral hospital. Thus geography and access to services become an important factor to note, especially in urban areas. RS is everywhere.

Atonia uteri can be managed with a Uterus massage together with the administration of oxytocin, prostaglandin and ergot alkaloids. Early introduction, systematic evaluation and treatment, and fluid ressusitation will soon minimize potentially serious results associated with postpartum hemorrhage. Home practice midwives have passed the test to be more skilled in the treatment of post-natal bleeding. The first to be sorted is about the origin of bleeding, which is 4T: Tone (contraction) if weak or absent then diagnosis of uterine atony, Trauma (birth canal) can occur by the tear or laceration deep enough so that the bleeding, Tissue (Network ) Checked the remaining placenta left in the uterus, and Thrombin (coagulopathy) examined the presence of blood disorders that inhibited the blood clotting process.

If the uterus is soft then the medical personnel will compress by putting one hand inside the vagina and clenching it while the other hand places the fundus from above through the abdominal wall. (See picture). The midwives will do that quickly and carefully to control the bleeding for the sake of mother's care even though the patient will feel pain. So please those moms who are experiencing it can tolerate our duties once more.

3. The most comfortable or the cheapest childbirth may not be in the hospital. But the most SAFE delivery remains in the hospital.

In the research data I obtained, 1-5% of women experienced post-natal bleeding and a greater likelihood of experiencing it was cesarean delivery. The average amount of blood loss after the birth of a single infant in vaginal delivery is 500 ml. While the average amount of blood loss for cesarean delivery is about 1000 ml.

The occurrence of uterine atony (uterus contracts) from SC Labor is almost certainly due to anesthesia. And there are some anti-inflammatory drugs obtained from the process that can cause contraction inhibition (contraction prevention / reduction). Therefore, in the flu the infusion is always given Uterotonika to stimulate uterine contractions again. The midwife in the hospital has repeatedly handled the case of post-screw uterine atony patients who are still in post-operative recovering (RR).

Then what about the choice of birth at midwife's home?

To open a practice at home can not be any Midwife, only those who are competent enough and through national standard exams. The permit letter will be issued when the midwife's house has been checked for the feasibility of standardized services and emergency tools. So for home delivery it is safe because it is standard for NORMAL LABOR.

The thing most likely to be the difference is the flying hours. Hours are standard that only direct clients can test. Whatever his profession. Home practice midwives are skilled in detection, handling or performing any referral grooves of any obstetric case including the cause of the bleeding.

I feel the hospital patient's hospital visits are increasing on the grounds that "if anything is to be handled sooner".

Okay, but in fact, on the contrary, I can represent the outpouring of friends of midwives in the arms of the hospital who feel complained by the number of referrals of puskesmas and midwife only with patient diagnose which according to us is not suitable for reference.

If the patient has already entered the hospital then the protap and handling of the patient's state of action will rise to the next stage. That's what the hospital was created, as a place to handle patients who can not be handled to undergo birth at midwife / community health center. RS overload is clearly not more profitable, even detrimental for both parties due to over capacity, quality of service down, the patient is not handled properly.

The delivery service is tiered to provide better service, and that is the way it should be. Every human life there are stages and classes respectively. If still in elementary school, which junior high school is willing to accept? It's still not the time. So also with pregnant women patients with a normal history that can still be handled by the midwife practice home.

4. Additional from me - Responsibility as a servant of Allah SWT

The existence of a maternity hospital / midwife is a national health strategy to be able to serve the maternity mother as closely as possible to the community, screening as early as possible, mentoring as intensively as possible, sharing duties with other medical colleagues for the welfare and health of the community, especially mothers and children. With the present condition there is still an imbalance in the amount of coverage of decent health services to the population. How can we answer if God asked about our profession in the Hereafter?

Worry it's okay but let's put it in the right portion. Fear and worry can be healed with good effort, learning and empowering, preparing things to prepare, fasting prayers to facilitate childbirth, improving relations with God and man, complete package with tawakalnya.

I have been reading the writings of these medical personnel, even though I did not follow the friendship because I am the only medical person who is horrified to read the writing that only smells thick with the medical so that it eliminates the element of Allah's presence and destiny in pregnancy and childbirth all the women in the world, There will be only one solution. Already we should improve the quality of service from various parties and work together in carrying out this mandate. For Mother, let's live peace in peace, with the right worry, soothing endeavor, create a beautiful and fun birthday as much as possible.

Wassalam.

Bidan Wina_Papilio NBC

Reff :
http://www.stanfordchildrens.org/en/topic/default…

https://www.midwiferytoday.com/articles/hemorrhage.asp

http://www.healthline.com/…/complications-delivery-uterine-…

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4832492/…

http://www.aafp.org/afp/2007/0315/p875.html

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3788839/

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