Which of the following is the correct list of first-line interventions for postpartum hemorrhage due to uterine atony?

• A. Antibiotics; bed rest; imaging studies
• B. Uterine massage; uterotonic medications (oxytocin, misoprostol); uterine compression/bimanual techniques; fluid resuscitation and blood products as needed.
• C. Surgical ligation; transfusion only
• D. Pain control; bed rest; fluid restriction

Answer: (B)

The main idea here is to rapidly restore uterine tone and stop the bleeding from a uterus that isn’t contracting well after delivery, while also supporting the mother’s circulation. Start with a firm massage of the uterus to stimulate contraction and reduce bleeding from the boggy uterus. Then give uterotonic medications, such as oxytocin and misoprostol, to promote sustained uterine contraction and help firm the uterus. If bleeding continues, apply uterine compression or perform a bimanual technique to physically compress the bleeding site and reinforce the uterus’s tone. Throughout this process, establish IV access and begin fluid resuscitation, with blood products as needed to treat hypovolemia from blood loss. These steps directly address the cause (uterine atony) and the consequences (circulatory compromise) and are undertaken before considering surgical options.

Antibiotics or imaging aren’t first-line responses to atony-related hemorrhage because they don’t stop the immediate bleeding or restore tone. Surgical ligation is a later intervention if medical and mechanical measures fail. Transfusion is important for blood loss, but it isn’t sufficient on its own without stopping the hemorrhage.