One hour after birth, a boggy fundus 1 cm below the umbilicus with profuse lochia and clots. What is the initial action?

• A. Place her on a bedpan to empty her bladder
• B. Massage her fundus
• C. Call the physician
• D. Administer Methergine 0.2 mg IM which has been ordered prn

Answer: (B)

Uterine atony is the most common cause of early postpartum hemorrhage, so the first action is to stimulate contraction by massaging the fundus. By applying firm, rhythmic massage to the top of the uterus and expressing any clots, you help the uterus contract and become firm, which reduces bleeding and helps prevent further hemorrhage. While massaging, ensure the uterus remains midline and assess the amount and rate of lochia along with vital signs. If the fundus firms with massage, continue to monitor; if it remains boggy after continuous Massage, proceed with the ordered uterotonic medications and notify the clinician as needed.