While collecting data from a postpartum client, a steady trickle of bright red blood is noted from the vagina. The uterus is firm and located 1 cm below the umbilicus. What should the nurse do?

• A. Notify the provider
• B. Massage the fundus
• C. Administer oxytocin as ordered
• D. Check blood pressure and pulse

Answer: (A)

When the uterus is firm and involuting normally but there is a steady trickle of bright red blood, the problem is likely a vaginal source of bleeding such as a laceration, episiotomy, or cervical tear rather than uterine atony. The priority is to have the provider assess for tears or other vaginal/cervical injuries and to determine appropriate repair or intervention. This is because a firm uterus means the uterus itself is contracting, so massage or uterotonics won’t stop bleeding from a vaginal source and could delay needed treatment.

Fundal massage is indicated for a boggy uterus, not when the uterus is firm. Administering oxytocin is aimed at uterine contractions to control atony, which isn’t the issue here. Checking vital signs remains important for assessing stability, but the immediate action that addresses the cause and potential escalation is notifying the provider for further evaluation and possible repair.