If a boggy fundus persists after massage and the bladder has been checked, what is the next step?

• A. Notify the provider for additional interventions (such as uterotonic meds).
• B. Advance to daily monitoring only.
• C. Discontinue all uterotonics.
• D. Ignore and discharge patient.

Answer: (A)

Persistent boggy fundus after massage means the uterus isn’t contracting well, so the next step is to bring in the provider for additional interventions to stimulate contraction. Even with the bladder empty, atony often requires pharmacologic help, so orders for uterotonic meds are started or adjusted. These meds—such as oxytocin infusion, methylergonovine, carboprost, or misoprostol—are chosen based on the patient’s status and contraindications. Ongoing assessment of fundal tone, bleeding, vital signs, and fluid status accompanies this treatment. Delaying or skipping these meds, or discharging the patient, would allow ongoing hemorrhage to worsen.