Which nursing assessment is most critical for early detection of postpartum hemorrhage?

• A. Monitoring breastfeeding success
• B. Continuous monitoring of vaginal bleeding, fundal tone, and vital signs
• C. Assessing infant feeding cues
• D. Recording weight gain

Answer: (B)

The most important concept here is recognizing postpartum hemorrhage early by watching for bleeding and uterine changes plus the body's response to blood loss. Postpartum hemorrhage is most often due to uterine atony, so a uterus that is boggy or not firm, coupled with ongoing vaginal bleeding, signals trouble well before a large amount of blood is lost. Keeping a continuous eye on the amount of bleeding, the fundal tone and position, and the mother’s vital signs lets you detect subtle worsening and intervene quickly—fundal massage, medications to contract the uterus, and fluid or blood replacement as needed.

Other postpartum observations don’t reliably indicate hemorrhage onset. Breastfeeding success, while important for bonding and physiology, doesn’t tell you about bleeding. Infant feeding cues reflect the baby’s readiness and feeding effectiveness, not the mother’s bleeding status. Recording weight gain tracks general fluid balance over time but not the acute changes of a hemorrhage.