Uterine atony is most commonly associated with postpartum hemorrhage in the immediate postpartum period. What is a key sign?

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Uterine atony occurs when the uterus loses its ability to contract after delivery, so it cannot compress the blood vessels at the placental site to stop the bleeding. In the immediate postpartum period, the most telling sign is heavy vaginal bleeding paired with a soft, boggy uterus. A firm, contracted uterus indicates good uterine tone and is not consistent with atony. Conversely, a uterus that is soft and boggy often fails to regain tone even with massage, allowing ongoing bleeding to occur. The other scenarios—minimal or no bleeding with an intact uterus, or painful contractions with a firm uterus—do not reflect the lack of uterine tone seen in atony and thus are not the typical signs of postpartum hemorrhage due to atony.