While caring for the client during the first hour after delivery, the nurse determines that the uterus is boggy and there is vaginal bleeding. What should be the nurse’s first action?
A. Check vital signs.
B. Massage the fundus.
C. Offer a bedpan.
D. Check for perineal lacerations.
Correct Answer: B. Massage the fundus
The nurse’s first action should be to massage the fundus until it is firm as uterine atony is the primary cause of bleeding in the first hour after delivery. Approximately 3% to 5% of obstetric patients will experience postpartum hemorrhage. Annually, these preventable events are the cause of one-fourth of maternal deaths worldwide and 12% of maternal deaths in the United States.
Option A: Vital signs should be checked after vaginal delivery, but in this situation, the nurse should prioritize prevention of bleeding. 20% of postpartum hemorrhage occurs in women with no risk factors, so physicians must be prepared to manage this condition at every delivery
Option C: The client’s fundus should be massaged first to prevent uterine atony and hemorrhage. Uterine atony is the most common cause of postpartum hemorrhage. Brisk blood flow after delivery of the placenta unresponsive to transabdominal massage should prompt immediate action including bimanual compression of the uterus and use of uterotonic medications. Massage is performed by placing one hand in the vagina and pushing against the body of the uterus while the other hand compresses the fundus from above through the abdominal wall
Option D: Perineal lacerations may be present but it is not a primary concern during uterine atony. Lacerations and hematomas due to birth trauma can cause significant blood loss that can be lessened by hemostasis and timely repair. Episiotomy increases the risk of blood loss and anal sphincter tears; this procedure should be avoided unless urgent delivery is necessary and the perineum is thought to be a limiting factor.