A boggy uterus is best described as which, and how should it be managed initially?

• A. A firm, contracted uterus; apply gentle massage only if bleeding.
• B. A uterus that is displaced to the side.
• C. A uterus that is soft and non-tender.
• D. A boggy uterus is soft and flabby; management includes fundal massage until firm, ensuring the bladder is empty, and monitoring bleeding.

Answer: (D)

A boggy uterus means uterine atony—the uterus is soft and flabby and fails to contract after delivery. This lack of contraction allows the placental vessels to bleed more freely, putting the patient at risk for postpartum hemorrhage. The best initial management is to perform fundal massage to stimulate contractions and firm the uterus, and to do so until it feels firm. At the same time, ensure the bladder is empty because a full bladder can prevent the uterus from contracting and keep it displaced, perpetuating the boggy state. While doing this, closely monitor the amount and pattern of vaginal bleeding and the patient’s vital signs to assess response and detect ongoing hemorrhage.