Which action is most critical when a postpartum client experiences hemorrhage?

• A. Administer antibiotics.
• B. Check blood glucose.
• C. Assess uterine tone and massage if boggy.
• D. Place patient in Trendelenburg.

Answer: (C)

Postpartum hemorrhage is most often caused by uterine atony, meaning the uterus isn’t contracting well enough to compress blood vessels after delivery. The most critical action is to assess how the uterus feels and, if it is soft and boggy, perform fundal massage to stimulate contraction. This directly targets the underlying problem—improving uterine tone to control bleeding. Once you’ve massaged to try to firm the fundus, you continue to monitor the uterus and bleeding and proceed with the next steps (urinary emptying, IV fluids, and appropriate uterotonic medications) if the tone remains boggy or bleeding continues.

Other options don’t address the immediate cause of bleeding. Antibiotics aren’t the first priority for a hemorrhage unless infection is suspected. Checking blood glucose isn’t relevant to the acute event. Placing the patient in Trendelenburg is not appropriate for postpartum hemorrhage and can worsen respiratory and perfusion status; if perfusion is compromised, the focus is on promoting venous return and uterine contraction, with left lateral positioning used to improve circulation rather than Trendelenburg.