Which postpartum finding requires urgent evaluation due to risk of hemorrhage?

• A. Mild fatigue
• B. Heavy vaginal bleeding with a boggy uterus
• C. Slight breast engorgement
• D. Normal vital signs

Answer: (B)

Uterine atony is the main idea here: when the uterus doesn’t contract firmly after delivery, vessels at the placental site stay open and heavy bleeding can occur. A boggy, or soft, uterus that cannot contract together with heavy vaginal bleeding is the classic sign that a hemorrhage could be starting or already happening, so it requires urgent evaluation and action. Immediate steps focus on stimulating contraction and stopping the bleed: perform fundal massage to encourage the uterus to firm up, ensure the bladder is empty, establish IV access, and start uterotonic medications (oxytocin is usually first-line, with additional agents as indicated). Closely monitor vital signs and blood loss, and be ready to escalate to more interventions or blood products if needed. While mild fatigue, breast engorgement, or normal vital signs can be normal postpartum findings, they do not indicate the same urgent risk for hemorrhage that heavy bleeding with a noncontracting uterus does.