TITLE:
The Active Management of Postpartum Uterine Atony—A Checklist Based Approach
AUTHORS:
Rachael Bailey, Michael R. Foley, Nicole Hall, Adiel Fleischer, Mary D’Alton, Gary A. Dildy, Michael A. Belfort, Gary D. Hankins, Steven L. Clark
KEYWORDS:
Postpartum Hemorrhage, Obstetric Hemorrhage, Uterine Atony
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.6 No.11,
September
28,
2016
ABSTRACT: Uterine
atony remains the major cause of postpartum hemorrhage, and of death from
postpartum hemorrhage in the United States. While existing guidelines outlining
a general approach to postpartum hemorrhage are useful, recent data suggest
that greater specificity may be necessary to significantly impact mortality. We
present a highly specific and methodical approach to the management of uterine
atony, which addresses what we believe to be the most common cause of
preventable maternal hemorrhagic death in the US—lack of an intensive, focused
approach to atony and perseverance with therapies that are not working. This
protocol should result in cessation of hemorrhage by medical or surgical means
within 1 hour of diagnosis. We then apply this protocol to a number of illustrative
cases of maternal death due to atony. An approach involving the active management of uterine atony may assist clinicians in avoiding severe morbidity and mortality from uterine
atony.