How is postpartum hemorrhage initially managed in the hospital setting?

• A. Call for help, fundal massage, ensure bladder is empty, administer uterotonic meds, monitor blood loss, establish IV access, prepare for possible transfusion or surgery
• B. Ignore symptoms and wait
• C. Only give pain relief
• D. Increase fluids only

Answer: (A)

Immediate, coordinated hemorrhage management starts with rapid assessment and actions to stop the bleed and stabilize the patient. Call for help and activate the hospital hemorrhage protocol so a team can respond quickly. If the uterus is soft and boggy, perform fundal massage to encourage contraction and reduce bleeding. Ensure the bladder is empty, because a full bladder can prevent the uterus from contracting firmly. Administer uterotonic medications promptly to promote uterine contraction; oxytocin is typically first-line, with other agents added as indicated by protocol. Keep careful track of blood loss and monitor vital signs to determine the severity and response to therapy. Establish two IV lines to provide fluids and medications and to facilitate blood product administration if transfusion becomes necessary. Prepare for possible transfusion or surgical intervention if bleeding continues despite medical measures. These steps address stopping the bleed, stabilizing the patient, and escalating appropriately if needed.