Which action should be avoided when the uterus is boggy and bleeding occurs?

• A. Massage the fundus until firm
• B. Elevate legs
• C. Push on the uterus to express clots
• D. Encourage voiding

Answer: (C)

Uterine atony, where the uterus doesn’t contract firmly, is the situation that leads to heavy postpartum bleeding. The aim is to make the uterus contract to compress the bleeding vessels. Gentle fundal massage is the primary maneuver because it stimulates contraction and helps firm the uterus. Supporting measures like elevating the legs can help with perfusion if the patient shows signs of shock, and encouraging voiding helps prevent bladder distension that can hinder contraction.

The action to avoid is pushing on the uterus to express clots. Applying manual pressure in this way can cause injury to the uterus and may even trigger inversion, and it doesn’t reliably control the bleeding. If clots are present, they should be managed through careful massage and appropriate medical interventions rather than forceful manual compression.