In the fourth stage of labor and notes the fundus is firm, but bleeding is excessive. Which should be the initial nursing action?

In the fourth stage of labor and notes the fundus is firm, but bleeding is excessive. Which should be the initial nursing action?

• A. Record the findings
• B. Massage the fundus
• C. Notify the obstetrician
• D. Place the client in Trendelenburg's position

Answer: (B)

In this situation the key idea is to support ongoing uterine contraction to control hemorrhage. Even though the fundus is firm, initiating fundal massage helps ensure the uterus remains contracted and can continue compressing the bleeding vessels at the placental site. Gentle, continuous massage acts as a practical way to reinforce the uterus’s ability to tamponade bleeding while you assess for other potential sources and monitor the patient closely. After starting massage, keep checking the fundus, lochia, and vital signs, ensure proper IV access and fluid status, and call for assistance if bleeding persists or the patient shows signs of instability. Placing the patient in Trendelenburg isn’t useful here, and recording findings can wait until immediate actions to control bleeding have begun. Notifying the obstetrician is important, but the first step is to promote contraction with fundal massage.

In this situation the key idea is to support ongoing uterine contraction to control hemorrhage. Even though the fundus is firm, initiating fundal massage helps ensure the uterus remains contracted and can continue compressing the bleeding vessels at the placental site. Gentle, continuous massage acts as a practical way to reinforce the uterus’s ability to tamponade bleeding while you assess for other potential sources and monitor the patient closely. After starting massage, keep checking the fundus, lochia, and vital signs, ensure proper IV access and fluid status, and call for assistance if bleeding persists or the patient shows signs of instability. Placing the patient in Trendelenburg isn’t useful here, and recording findings can wait until immediate actions to control bleeding have begun. Notifying the obstetrician is important, but the first step is to promote contraction with fundal massage.